Provider Demographics
NPI:1275719080
Name:290 PAIN & REHABILITATION CENTER
Entity Type:Organization
Organization Name:290 PAIN & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THAO
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-290-1881
Mailing Address - Street 1:10900 NORTHWEST FWY STE 115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-7309
Mailing Address - Country:US
Mailing Address - Phone:713-290-1881
Mailing Address - Fax:713-290-1616
Practice Address - Street 1:10900 NORTHWEST FWY STE 115
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7309
Practice Address - Country:US
Practice Address - Phone:713-290-1881
Practice Address - Fax:713-290-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty