Provider Demographics
NPI:1780692921
Name:POINDEXTER, PHILLIP (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:POINDEXTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 GRAND RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2483
Mailing Address - Country:US
Mailing Address - Phone:281-642-8342
Mailing Address - Fax:281-599-3710
Practice Address - Street 1:956 S FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3062
Practice Address - Country:US
Practice Address - Phone:281-599-1800
Practice Address - Fax:281-599-3710
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU95488Medicare UPIN
TX838385Medicare ID - Type Unspecified