Provider Demographics
NPI:1265058473
Name:CHIROSPORTS PERFORMANCE & REHAB
Entity type:Organization
Organization Name:CHIROSPORTS PERFORMANCE & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-586-7183
Mailing Address - Street 1:4305 GLENWOOD AVE APT 1003
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-5779
Mailing Address - Country:US
Mailing Address - Phone:832-556-3652
Mailing Address - Fax:
Practice Address - Street 1:1225 NORTH LOOP W STE 1010
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4722
Practice Address - Country:US
Practice Address - Phone:832-586-7183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty