Provider Demographics
NPI:1467876250
Name:INTEGRATED CHIROPRACTIC & HEALTH
Entity Type:Organization
Organization Name:INTEGRATED CHIROPRACTIC & HEALTH
Other - Org Name:INTEGRATED CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-346-8023
Mailing Address - Street 1:29818 FM 1093 RD
Mailing Address - Street 2:210
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-3918
Mailing Address - Country:US
Mailing Address - Phone:281-346-8023
Mailing Address - Fax:281-346-8045
Practice Address - Street 1:29818 FM 1093 RD STE 205
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-3919
Practice Address - Country:US
Practice Address - Phone:281-346-8023
Practice Address - Fax:281-346-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z147OtherMEDICARE PROVIDER