Provider Demographics
NPI:1588734503
Name:CHAMPION, THELMA (DC)
Entity type:Individual
Prefix:DR
First Name:THELMA
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-6131
Mailing Address - Country:US
Mailing Address - Phone:713-467-5367
Mailing Address - Fax:713-467-0937
Practice Address - Street 1:12421 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-6131
Practice Address - Country:US
Practice Address - Phone:713-467-5367
Practice Address - Fax:713-467-0937
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6650OtherCHIROPRACTIC LICENSE
TX760646665OtherTAX ID NUMBER
TX6650OtherCHIROPRACTIC LICENSE
TX605422Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID