Provider Demographics
NPI:1407963283
Name:UPTOWN FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:UPTOWN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-532-2555
Mailing Address - Street 1:5701 WOODWAY DRIVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:713-532-2555
Mailing Address - Fax:713-532-2999
Practice Address - Street 1:5701 WOODWAY DRIVE
Practice Address - Street 2:SUITE 225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-532-2555
Practice Address - Fax:713-532-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX7968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U72140Medicare UPIN
TX609133Medicare ID - Type Unspecified