Provider Demographics
NPI:1245498286
Name:DIAGNOSTIC AND INTERVENTIONAL SPINE CENTER, P.A.
Entity type:Organization
Organization Name:DIAGNOSTIC AND INTERVENTIONAL SPINE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:EFIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-536-3119
Mailing Address - Street 1:5802 HORSESHOE FLS
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6914
Mailing Address - Country:US
Mailing Address - Phone:281-536-3119
Mailing Address - Fax:
Practice Address - Street 1:4120 SW FWY STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7327
Practice Address - Country:US
Practice Address - Phone:713-355-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty