Provider Demographics
NPI:1750583282
Name:COMPLETE CARE CHIROPRACTIC
Entity type:Organization
Organization Name:COMPLETE CARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-835-7676
Mailing Address - Street 1:3965 PHELAN BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707
Mailing Address - Country:US
Mailing Address - Phone:409-835-7676
Mailing Address - Fax:409-835-5106
Practice Address - Street 1:3965 PHELAN BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-835-7676
Practice Address - Fax:409-835-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68562111N00000X
TX6984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69195Medicare UPIN
TX00453VMedicare PIN