Provider Demographics
NPI:1679104939
Name:SOUTHEAST SPINE AND REHAB
Entity Type:Organization
Organization Name:SOUTHEAST SPINE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRIKZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-645-3536
Mailing Address - Street 1:8470 GULF FWY STE G
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-5026
Mailing Address - Country:US
Mailing Address - Phone:713-645-3536
Mailing Address - Fax:713-645-3940
Practice Address - Street 1:8470 GULF FWY STE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-5026
Practice Address - Country:US
Practice Address - Phone:713-645-3536
Practice Address - Fax:713-645-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty