Provider Demographics
NPI:1265087548
Name:GALVESTON CHIROPRACTIC
Entity type:Organization
Organization Name:GALVESTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-609-8707
Mailing Address - Street 1:907 EL DORADO BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062
Mailing Address - Country:US
Mailing Address - Phone:409-299-3777
Mailing Address - Fax:409-515-1940
Practice Address - Street 1:1023 21ST STREET
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-299-3777
Practice Address - Fax:409-515-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty