Provider Demographics
NPI:1396862066
Name:COUNTRY PLACE CHIROPRACTIC HEALTH & WELLNESS
Entity Type:Organization
Organization Name:COUNTRY PLACE CHIROPRACTIC HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CULLINANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-436-8346
Mailing Address - Street 1:1801 COUNTRY PLACE PKWY
Mailing Address - Street 2:113
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5120
Mailing Address - Country:US
Mailing Address - Phone:713-436-8346
Mailing Address - Fax:713-436-8356
Practice Address - Street 1:1801 COUNTRY PLACE PKWY
Practice Address - Street 2:113
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5120
Practice Address - Country:US
Practice Address - Phone:713-436-8346
Practice Address - Fax:713-436-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076MUOtherBCBS GROUP NUMBER