Provider Demographics
NPI:1033567961
Name:SANDSTONE CHIROPRACTIC CONROE, PLLC
Entity Type:Organization
Organization Name:SANDSTONE CHIROPRACTIC CONROE, PLLC
Other - Org Name:SANDSTONE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-582-0404
Mailing Address - Street 1:1336 LEAGUE LINE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3423
Mailing Address - Country:US
Mailing Address - Phone:936-582-0404
Mailing Address - Fax:
Practice Address - Street 1:1336 LEAGUE LINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3423
Practice Address - Country:US
Practice Address - Phone:936-582-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty