Provider Demographics
NPI:1316010127
Name:MCINTYRE, JOHN ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:ERIC
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1819 BROADWAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5670
Mailing Address - Country:US
Mailing Address - Phone:281-993-9333
Mailing Address - Fax:281-993-0634
Practice Address - Street 1:1819 BROADWAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5670
Practice Address - Country:US
Practice Address - Phone:281-993-9333
Practice Address - Fax:281-993-0634
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06267Medicare UPIN
TX8F0859Medicare ID - Type Unspecified