1063656999 NPI number — CHIROPRACTIC FAMILY HEALTH CENTER

Table of content: LICET VALOIS LMSW, MPS (NPI 1518343326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063656999 NPI number — CHIROPRACTIC FAMILY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC FAMILY HEALTH CENTER
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:
1063656999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2274 W HOLCOMBE BLVD
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:
77030-2008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-667-6782
Provider Business Mailing Address Fax Number:
713-667-6790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2274 W HOLCOMBE BLVD
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:
77030-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-667-6782
Provider Business Practice Location Address Fax Number:
713-667-6790
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
OWNER/DR
Authorized Official Telephone Number:
713-667-6782

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  9535 , 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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