Provider Demographics
NPI:1831481126
Name:TEJAS SPINE AND REHAB LLC
Entity Type:Organization
Organization Name:TEJAS SPINE AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAIMONDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-767-2538
Mailing Address - Street 1:3222 BURKE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1859
Mailing Address - Country:US
Mailing Address - Phone:832-767-2538
Mailing Address - Fax:832-767-2562
Practice Address - Street 1:3222 BURKE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1859
Practice Address - Country:US
Practice Address - Phone:832-767-2538
Practice Address - Fax:832-767-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty