1326056698 NPI number — MICHAEL C. WALTHER JR. D.C.

Table of content: (NPI 1326056698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326056698 NPI number — MICHAEL C. WALTHER JR. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL C. WALTHER JR. D.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COPPERFIELD FAMILY CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326056698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7171 HIGHWAY 6 N STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77095-2422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-550-0650
Provider Business Mailing Address Fax Number:
281-815-3678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7050 LAKEVIEW HAVEN DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77095-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-550-0650
Provider Business Practice Location Address Fax Number:
281-550-0590
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTHER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-550-0650

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6924 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2237276 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 606673 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 662634 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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