Provider Demographics
NPI:1225452378
Name:GULF COAST WELLNESS & REHABILITATION
Entity Type:Organization
Organization Name:GULF COAST WELLNESS & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-534-1133
Mailing Address - Street 1:3750 MEDICAL PARK DRIVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7385
Mailing Address - Country:US
Mailing Address - Phone:281-534-1133
Mailing Address - Fax:281-534-2190
Practice Address - Street 1:3750 MEDICAL PARK DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-7385
Practice Address - Country:US
Practice Address - Phone:281-534-1133
Practice Address - Fax:281-534-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8030111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty