1235296351 NPI number — ALTERNATIVE MEDICINE CLINIC

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 1235296351 NPI number — ALTERNATIVE MEDICINE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE MEDICINE CLINIC
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:
DBA DR. PETER CHAN
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:
1235296351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ALTERNATIVE MEDICINE CLINIC
Provider Second Line Business Mailing Address:
11221 RICHMOND AVE C110
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-480-0504
Provider Business Mailing Address Fax Number:
281-920-4599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11221 RICHMOND AVE # C110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77082-6655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-480-0504
Provider Business Practice Location Address Fax Number:
281-920-4599
Provider Enumeration Date:
01/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-480-0504

Provider Taxonomy Codes

  • Taxonomy code: 111NI0900X , with the licence number:  8129 , 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)