1356782023 NPI number — PRP CHIROPRACTIC SERVICES

Table of content: MRS. JANETH VARON OTR/L CLT (NPI 1700971348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356782023 NPI number — PRP CHIROPRACTIC SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRP CHIROPRACTIC SERVICES
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:
HEALTHSOURCE OF BAYTOWN
Provider Other Organization Name Type Code:
3
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:
1356782023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4520 S FM 565 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77523-4884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-383-0004
Provider Business Mailing Address Fax Number:
281-383-0007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4520 S FM 565 RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77523-4884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-383-0004
Provider Business Practice Location Address Fax Number:
281-383-0007
Provider Enumeration Date:
07/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PUCKETT
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-383-0004

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8264 , 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)