Provider Demographics
NPI:1639333024
Name:SOUTH HOUSTON CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SOUTH HOUSTON CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-946-7841
Mailing Address - Street 1:PO BOX 5238
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5238
Mailing Address - Country:US
Mailing Address - Phone:713-946-7841
Mailing Address - Fax:281-991-7617
Practice Address - Street 1:6733 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4403
Practice Address - Country:US
Practice Address - Phone:713-946-7841
Practice Address - Fax:281-991-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350032561OtherPALMETTO GBA/RAILROAD MEDICARE
TXT13957Medicare UPIN
TX600985Medicare PIN