Provider Demographics
NPI:1811282148
Name:GHOLSON, DONALD JERRY (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JERRY
Last Name:GHOLSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 CLARKDALE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-3208
Mailing Address - Country:US
Mailing Address - Phone:713-320-1333
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU-81372Medicare UPIN
TX609415Medicare PIN