Provider Demographics
NPI:1023180619
Name:ST JOHN THERAPY CENTER INC
Entity Type:Organization
Organization Name:ST JOHN THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANUABU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-270-4955
Mailing Address - Street 1:10101 HARWIN DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-270-4955
Mailing Address - Fax:713-270-4487
Practice Address - Street 1:10101 HARWIN DR
Practice Address - Street 2:SUITE 180
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-270-4955
Practice Address - Fax:713-270-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10138111N00000X
TX5616111N00000X
TX9248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty