Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 9653 | TX |
NPI | 1063571263 |
---|---|
Provider Name | Chad Manly Caussey |
First Address | San Antonio, TX 78232-5052 |
Second Address | Keller, TX 76248-4235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 13/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1705253-01 | (05) | TX |
U98598 | (02) | TX |