Provider Demographics
NPI: | 1710430384 |
---|---|
Name: | HEIGHTS SPINE WELLNESS |
Entity Type: | Organization |
Organization Name: | HEIGHTS SPINE WELLNESS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SANDEEP |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | PATEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 713-864-9494 |
Mailing Address - Street 1: | 2020 N DURHAM DR |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77008-3518 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-864-9494 |
Mailing Address - Fax: | 713-886-4949 |
Practice Address - Street 1: | 2020 N DURHAM DR |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77008-3518 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-864-9494 |
Practice Address - Fax: | 713-886-4949 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-07-29 |
Last Update Date: | 2016-07-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 6319 | Other | STATE LICENSES |