Provider Demographics
NPI:1245434422
Name:CHIRO MEDICAL ACUPUNCTURE CENTER
Entity type:Organization
Organization Name:CHIRO MEDICAL ACUPUNCTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-564-8909
Mailing Address - Street 1:6988 WILCREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2626
Mailing Address - Country:US
Mailing Address - Phone:281-564-8909
Mailing Address - Fax:
Practice Address - Street 1:6988 WILCREST DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2626
Practice Address - Country:US
Practice Address - Phone:281-564-8909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
TXF5948208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00575YMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER