Provider Demographics
NPI:1801189071
Name:ESSENTIAL SPORT & WELLNESS CHIROPRACTIC
Entity Type:Organization
Organization Name:ESSENTIAL SPORT & WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-873-1166
Mailing Address - Street 1:4810 W PANTHER CREEK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-5005
Mailing Address - Country:US
Mailing Address - Phone:713-873-1166
Mailing Address - Fax:
Practice Address - Street 1:4810 W PANTHER CREEK DR STE 105
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-5005
Practice Address - Country:US
Practice Address - Phone:713-873-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-22
Last Update Date:2011-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty