Provider Demographics
NPI:1811393200
Name:ALPHA/OMEGA CHIROPRACTIC & WELLNESS UTOPIA
Entity Type:Organization
Organization Name:ALPHA/OMEGA CHIROPRACTIC & WELLNESS UTOPIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:832-969-6744
Mailing Address - Street 1:2101 CRAWFORD ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8941
Mailing Address - Country:US
Mailing Address - Phone:346-444-5225
Mailing Address - Fax:346-444-5224
Practice Address - Street 1:2101 CRAWFORD ST STE 207
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8941
Practice Address - Country:US
Practice Address - Phone:346-444-5225
Practice Address - Fax:346-444-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03050261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center