Provider Demographics
NPI:1356640791
Name:NEUROMUSCULAR PAIN & NUTRITION CENTER LLC
Entity Type:Organization
Organization Name:NEUROMUSCULAR PAIN & NUTRITION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:FRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:210-558-3112
Mailing Address - Street 1:8607 WURZBACH RD
Mailing Address - Street 2:BLDG R SUITE #150
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1303
Mailing Address - Country:US
Mailing Address - Phone:210-558-3112
Mailing Address - Fax:210-558-3114
Practice Address - Street 1:8607 WURZBACH RD
Practice Address - Street 2:BLDG R SUITE #150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1303
Practice Address - Country:US
Practice Address - Phone:210-558-3112
Practice Address - Fax:210-558-3114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROMUSCULAR PAIN & NUTRITION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00041261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service