Provider Demographics
NPI:1578828232
Name:CEDARS CHIROPRACTIC AND WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:CEDARS CHIROPRACTIC AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-557-3339
Mailing Address - Street 1:1100 GULF FWY S
Mailing Address - Street 2:STE 122
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5153
Mailing Address - Country:US
Mailing Address - Phone:281-557-3339
Mailing Address - Fax:832-932-5223
Practice Address - Street 1:1100 GULF FWY S
Practice Address - Street 2:STE 122
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5153
Practice Address - Country:US
Practice Address - Phone:281-557-3339
Practice Address - Fax:832-932-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7404261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center