Provider Demographics
NPI:1639506223
Name:THE KNEAD MEDMASSAGE LLC
Entity Type:Organization
Organization Name:THE KNEAD MEDMASSAGE LLC
Other - Org Name:THE KNEAD MEDMASSAGE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SPEERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-304-3443
Mailing Address - Street 1:5301 VILLAGE CREEK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4838
Mailing Address - Country:US
Mailing Address - Phone:469-304-3443
Mailing Address - Fax:469-304-3443
Practice Address - Street 1:5301 VILLAGE CREEK DR
Practice Address - Street 2:SUITE B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4838
Practice Address - Country:US
Practice Address - Phone:469-304-3443
Practice Address - Fax:469-304-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty