Provider Demographics
NPI:1376806919
Name:WHOLESOME LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:WHOLESOME LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIVA
Authorized Official - Middle Name:LORAINE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-741-3391
Mailing Address - Street 1:3375 WESTPARK DR # 314
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-4262
Mailing Address - Country:US
Mailing Address - Phone:832-741-3391
Mailing Address - Fax:
Practice Address - Street 1:5925 ALMEDA RD FL 6
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7602
Practice Address - Country:US
Practice Address - Phone:832-741-3391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty