Provider Demographics
NPI:1164701009
Name:SELECT SPINE AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:SELECT SPINE AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DENKE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:281-814-0556
Mailing Address - Street 1:1100 S FRIENDSWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4825
Mailing Address - Country:US
Mailing Address - Phone:281-993-2122
Mailing Address - Fax:281-993-2123
Practice Address - Street 1:1100 S FRIENDSWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4825
Practice Address - Country:US
Practice Address - Phone:281-993-2122
Practice Address - Fax:281-993-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11638111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty