1942821368 NPI number — STARK CHIROPRACTIC & SPORTS, PLLC

Table of content: (NPI 1942821368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942821368 NPI number — STARK CHIROPRACTIC & SPORTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STARK CHIROPRACTIC & SPORTS, PLLC
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:
6
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:
1942821368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5625 FM 1960 RD W STE 400
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:
77069-4211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-836-5908
Provider Business Mailing Address Fax Number:
281-836-5909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 CYPRESSWOOD DR STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-7105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-547-8930
Provider Business Practice Location Address Fax Number:
281-547-8931
Provider Enumeration Date:
04/27/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STARK
Authorized Official First Name:
SHEA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
281-547-8930

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4132961 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".