Provider Demographics
NPI:1578947032
Name:PINNACLE CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:PINNACLE CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TELLIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-687-9404
Mailing Address - Street 1:4635 SOUTHWEST FWY
Mailing Address - Street 2:#715
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7169
Mailing Address - Country:US
Mailing Address - Phone:832-687-9404
Mailing Address - Fax:
Practice Address - Street 1:3102 BIRCH LANDING CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-6810
Practice Address - Country:US
Practice Address - Phone:832-687-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty