Provider Demographics
NPI:1801674940
Name:KHAMHAENG, POTSAWAT (DC)
Entity type:Individual
Prefix:
First Name:POTSAWAT
Middle Name:
Last Name:KHAMHAENG
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 1:4611 PRESTON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7601
Mailing Address - Country:US
Mailing Address - Phone:469-200-5046
Mailing Address - Fax:
Practice Address - Street 1:4611 PRESTON RD STE 150
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7601
Practice Address - Country:US
Practice Address - Phone:469-200-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor