Provider Demographics
NPI:1437484656
Name:CHIROPRACTIC NUTRITION SOLUTIONS
Entity Type:Organization
Organization Name:CHIROPRACTIC NUTRITION SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-526-2225
Mailing Address - Street 1:1931 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3486
Mailing Address - Country:US
Mailing Address - Phone:713-526-2225
Mailing Address - Fax:
Practice Address - Street 1:1931 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3486
Practice Address - Country:US
Practice Address - Phone:713-526-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty