Provider Demographics
NPI:1447689740
Name:QUEEN, PAUL (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:QUEEN
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 1:138 NATCHES TRCE
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-7903
Mailing Address - Country:US
Mailing Address - Phone:806-392-0909
Mailing Address - Fax:
Practice Address - Street 1:763 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273-4505
Practice Address - Country:US
Practice Address - Phone:806-392-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor