Provider Demographics
NPI:1669741849
Name:KOUDELKA HEALTH CENTER, LLC
Entity type:Organization
Organization Name:KOUDELKA HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOUDELKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-229-0612
Mailing Address - Street 1:2814 HUNTINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9421
Mailing Address - Country:US
Mailing Address - Phone:281-229-0612
Mailing Address - Fax:281-412-4629
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:SUITE 295
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:281-229-0612
Practice Address - Fax:281-412-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10355111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty