Provider Demographics
NPI:1235296351
Name:ALTERNATIVE MEDICINE CLINIC
Entity Type:Organization
Organization Name:ALTERNATIVE MEDICINE CLINIC
Other - Org Name:DBA DR. PETER CHAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-480-0504
Mailing Address - Street 1:ALTERNATIVE MEDICINE CLINIC
Mailing Address - Street 2:11221 RICHMOND AVE C110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:713-480-0504
Mailing Address - Fax:281-920-4599
Practice Address - Street 1:11221 RICHMOND AVE # C110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6655
Practice Address - Country:US
Practice Address - Phone:713-480-0504
Practice Address - Fax:281-920-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8129111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610287Medicare PIN