Provider Demographics
NPI:1073637260
Name:KOALA HEALTH & WELLNESS CENTERS INC.
Entity Type:Organization
Organization Name:KOALA HEALTH & WELLNESS CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KIEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-652-9777
Mailing Address - Street 1:4665 SW FWY
Mailing Address - Street 2:#214
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-652-9777
Mailing Address - Fax:713-651-0584
Practice Address - Street 1:4665 SW FWY
Practice Address - Street 2:#214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-652-9777
Practice Address - Fax:713-651-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF004567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0008EROtherBCBS GROUP ID