Healthcare Provider Details

I. General information

NPI: 1467450460
Provider Name (Legal Business Name): PAUL ANDREW WILLMON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15202 MASON RD SUITE 800
CYPRESS TX
77433-9911
US

IV. Provider business mailing address

15202 MASON RD SUITE 800
CYPRESS TX
77433-9911
US

V. Phone/Fax

Practice location:
  • Phone: 281-256-8100
  • Fax: 281-256-8163
Mailing address:
  • Phone: 281-256-8100
  • Fax: 281-256-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8272
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: