Provider Demographics
NPI:1245987262
Name:SUPREME CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:SUPREME CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCCA
Authorized Official - Prefix:
Authorized Official - First Name:ROFFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-455-8638
Mailing Address - Street 1:10333 HARWIN DR STE 370
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1675
Mailing Address - Country:US
Mailing Address - Phone:713-636-2226
Mailing Address - Fax:713-360-6964
Practice Address - Street 1:10333 HARWIN DR STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1675
Practice Address - Country:US
Practice Address - Phone:713-636-2226
Practice Address - Fax:713-360-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty