Provider Demographics
NPI:1184091837
Name:SOUTHEAST INJURY CLINIC
Entity type:Organization
Organization Name:SOUTHEAST INJURY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:W
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-434-8899
Mailing Address - Street 1:8866 GULF FWY STE 122
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-6528
Mailing Address - Country:US
Mailing Address - Phone:832-834-5096
Mailing Address - Fax:832-834-5220
Practice Address - Street 1:8866 GULF FWY STE 122
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-6528
Practice Address - Country:US
Practice Address - Phone:832-834-5096
Practice Address - Fax:832-834-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty