Provider Demographics
NPI:1497470520
Name:100 CHIRO CARR MAMEDLY PLLC
Entity Type:Organization
Organization Name:100 CHIRO CARR MAMEDLY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-349-9826
Mailing Address - Street 1:4821 LJ PKWY STE 20
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4987
Mailing Address - Country:US
Mailing Address - Phone:832-660-1501
Mailing Address - Fax:
Practice Address - Street 1:4821 LJ PKWY STE 20
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4987
Practice Address - Country:US
Practice Address - Phone:832-660-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty