Provider Demographics
NPI:1467825992
Name:CHANDLER INJURY REHAB CLINIC, LLC
Entity Type:Organization
Organization Name:CHANDLER INJURY REHAB CLINIC, LLC
Other - Org Name:CHANDLER INJURY AND REHAB CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-981-5167
Mailing Address - Street 1:10610 FONDREN RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5422
Mailing Address - Country:US
Mailing Address - Phone:713-981-5167
Mailing Address - Fax:713-981-5553
Practice Address - Street 1:10610 FONDREN RD
Practice Address - Street 2:SUITE 124
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5422
Practice Address - Country:US
Practice Address - Phone:713-981-5167
Practice Address - Fax:713-981-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty