Provider Demographics
NPI:1982226783
Name:HEALTHSOURCE OF KATY WEST
Entity Type:Organization
Organization Name:HEALTHSOURCE OF KATY WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-517-0911
Mailing Address - Street 1:1417 FM 1463 RD STE 140
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5456
Mailing Address - Country:US
Mailing Address - Phone:832-517-0911
Mailing Address - Fax:
Practice Address - Street 1:1417 FM 1463 RD STE 140
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5456
Practice Address - Country:US
Practice Address - Phone:832-517-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11987OtherSTATE LICENSE