Provider Demographics
NPI:1063643146
Name:NEW LIFE SOURCE CHIROPRACTIC, LLC.
Entity Type:Organization
Organization Name:NEW LIFE SOURCE CHIROPRACTIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KRESS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-621-2600
Mailing Address - Street 1:2415 W ALABAMA ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-2262
Mailing Address - Country:US
Mailing Address - Phone:713-621-2600
Mailing Address - Fax:713-521-2604
Practice Address - Street 1:2415 W ALABAMA ST
Practice Address - Street 2:SUITE 212
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-2262
Practice Address - Country:US
Practice Address - Phone:713-621-2600
Practice Address - Fax:713-521-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty