Provider Demographics
NPI:1518046150
Name:ALLENDALE BONE & JOINT CLINIC, INC
Entity Type:Organization
Organization Name:ALLENDALE BONE & JOINT CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-472-4414
Mailing Address - Street 1:PO BOX 75250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77234
Mailing Address - Country:US
Mailing Address - Phone:713-472-4414
Mailing Address - Fax:713-472-3016
Practice Address - Street 1:1210 ALLENDALE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-3306
Practice Address - Country:US
Practice Address - Phone:713-472-4414
Practice Address - Fax:713-472-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO86Y9228Medicaid
TXTXB112783Medicare PIN
TXU595661Medicare UPIN
TX605409Medicare PIN