1205071388 NPI number — HEALTHSOURCE CHIROPRACTIC OF WEST MEMORIAL

Table of content: JESSICA NICOLE POWELL DO (NPI 1386893832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205071388 NPI number — HEALTHSOURCE CHIROPRACTIC OF WEST MEMORIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHSOURCE CHIROPRACTIC OF WEST MEMORIAL
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:
1205071388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12288 WESTHEIMER RD STE 310
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:
77077-6052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-497-3472
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12288 WESTHEIMER RD STE 310
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:
77077-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-497-3472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HEERSINK
Authorized Official First Name:
ROLAND
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-286-2229

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , 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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