1013249556 NPI number — SPINETASTIK - THE FUTURE OF CHIROPRACTIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013249556 NPI number — SPINETASTIK - THE FUTURE OF CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINETASTIK - THE FUTURE OF CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013249556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14731 BELTERRAZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77083-6760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-391-0269
Provider Business Mailing Address Fax Number:
281-469-7315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11211 KATY FWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77079-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-250-8425
Provider Business Practice Location Address Fax Number:
713-589-8844
Provider Enumeration Date:
02/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LUNA
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
713-391-0269

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11271 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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