Healthcare Provider Details

I. General information

NPI: 1760574404
Provider Name (Legal Business Name): KILLOUGH ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N 7TH STREET
BALLINGER TX
76821
US

IV. Provider business mailing address

106 N 7TH STREET
BALLINGER TX
76821
US

V. Phone/Fax

Practice location:
  • Phone: 325-365-8888
  • Fax: 325-365-2331
Mailing address:
  • Phone: 325-365-8888
  • Fax: 325-365-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC8055
License Number StateTX

VIII. Authorized Official

Name: MR. DANNY R KILLOUGH JR.
Title or Position: PRESIDENT
Credential: DC
Phone: 325-365-8888