Provider Demographics
NPI:1659657484
Name:CHIROPRACTIC SPORTS THERAPY & WELLNESS CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC SPORTS THERAPY & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:CHRISTEN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-736-8863
Mailing Address - Street 1:11200 BROADWAY ST
Mailing Address - Street 2:STE 2743
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9785
Mailing Address - Country:US
Mailing Address - Phone:832-895-6620
Mailing Address - Fax:832-436-2793
Practice Address - Street 1:11200 BROADWAY ST
Practice Address - Street 2:STE 2743
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9785
Practice Address - Country:US
Practice Address - Phone:832-895-6620
Practice Address - Fax:832-436-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10751111N00000X
TX10748111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty