Provider Demographics
NPI:1710347240
Name:CHUKWUMA, BETHEL GODSWILL (DC)
Entity Type:Individual
Prefix:
First Name:BETHEL
Middle Name:GODSWILL
Last Name:CHUKWUMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 HIGHWAY 6 S STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-3149
Mailing Address - Country:US
Mailing Address - Phone:281-258-4123
Mailing Address - Fax:
Practice Address - Street 1:3310 HIGHWAY 6 S STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-3149
Practice Address - Country:US
Practice Address - Phone:281-258-4123
Practice Address - Fax:281-670-5187
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12667111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation