Provider Demographics
NPI:1750630208
Name:NEW LIFE SOURCE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NEW LIFE SOURCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KRESS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:713-621-2600
Mailing Address - Street 1:3100 TIMMONS LN STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5925
Mailing Address - Country:US
Mailing Address - Phone:713-621-2600
Mailing Address - Fax:713-893-6907
Practice Address - Street 1:3100 TIMMONS LN STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5925
Practice Address - Country:US
Practice Address - Phone:713-621-2600
Practice Address - Fax:713-893-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty