Provider Demographics
NPI:1942487657
Name:CHIRO-PLUS REHABILITATION CLINIC INC
Entity Type:Organization
Organization Name:CHIRO-PLUS REHABILITATION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAPHAEL
Authorized Official - Last Name:FAZZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-342-4155
Mailing Address - Street 1:5101 AVE H
Mailing Address - Street 2:STE 25
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471
Mailing Address - Country:US
Mailing Address - Phone:281-342-4155
Mailing Address - Fax:281-342-5132
Practice Address - Street 1:5101 AVE H
Practice Address - Street 2:STE 25
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471
Practice Address - Country:US
Practice Address - Phone:281-342-4155
Practice Address - Fax:281-342-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z889OtherMEDICARE PROVIDER NUMBER
TXUU62568Medicare UPIN