Provider Demographics
NPI:1942833074
Name:ENOVATE SPORTSMED LLC
Entity Type:Organization
Organization Name:ENOVATE SPORTSMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUDOGBU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-713-1173
Mailing Address - Street 1:18006 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5862
Mailing Address - Country:US
Mailing Address - Phone:985-713-1173
Mailing Address - Fax:214-279-6025
Practice Address - Street 1:7504 SAN JACINTO PL
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3233
Practice Address - Country:US
Practice Address - Phone:985-713-1173
Practice Address - Fax:214-279-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty