Provider Demographics
NPI:1255936621
Name:MISSOURI CITY CHIROPRACTIC AND REHAB CLINIC
Entity type:Organization
Organization Name:MISSOURI CITY CHIROPRACTIC AND REHAB CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:X
Authorized Official - Credentials:DC
Authorized Official - Phone:832-440-7690
Mailing Address - Street 1:2755 TEXAS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5114
Mailing Address - Country:US
Mailing Address - Phone:832-430-7690
Mailing Address - Fax:832-440-7693
Practice Address - Street 1:2755 TEXAS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5114
Practice Address - Country:US
Practice Address - Phone:832-430-7690
Practice Address - Fax:832-440-7693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:85380459
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-02
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty