Provider Demographics
NPI:1780184507
Name:MY SPORT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MY SPORT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BABUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-556-5200
Mailing Address - Street 1:6370 N ELDRIDGE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-3517
Mailing Address - Country:US
Mailing Address - Phone:281-556-5200
Mailing Address - Fax:281-556-5251
Practice Address - Street 1:6370 N ELDRIDGE PKWY STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-3517
Practice Address - Country:US
Practice Address - Phone:281-556-5200
Practice Address - Fax:281-556-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty