Provider Demographics
NPI:1356983712
Name:COMPLETE BODYWORK AND WELLNESS PLLC
Entity type:Organization
Organization Name:COMPLETE BODYWORK AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-870-1233
Mailing Address - Street 1:1880 S DAIRY ASHFORD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4759
Mailing Address - Country:US
Mailing Address - Phone:281-870-1233
Mailing Address - Fax:281-870-1037
Practice Address - Street 1:1880 S DAIRY ASHFORD RD STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4759
Practice Address - Country:US
Practice Address - Phone:281-870-1233
Practice Address - Fax:281-870-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty