Provider Demographics
NPI:1861813438
Name:SANDSTONE CHIROPRACTIC MAGNOLIA, PLLC
Entity Type:Organization
Organization Name:SANDSTONE CHIROPRACTIC MAGNOLIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DERAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-582-0404
Mailing Address - Street 1:6875 FM 1488
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:MAGNOLLA
Mailing Address - State:TX
Mailing Address - Zip Code:77354
Mailing Address - Country:US
Mailing Address - Phone:281-789-7586
Mailing Address - Fax:281-789-7396
Practice Address - Street 1:6875 FM 1488
Practice Address - Street 2:SUITE 1300
Practice Address - City:MAGNOLLA
Practice Address - State:TX
Practice Address - Zip Code:77354
Practice Address - Country:US
Practice Address - Phone:281-789-7586
Practice Address - Fax:281-789-7396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDSTONE CHIROPRACTIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty