Provider Demographics
NPI:1720084288
Name:TEXAS CHIROPRACTIC COLLEGE FOUNDATION INC
Entity Type:Organization
Organization Name:TEXAS CHIROPRACTIC COLLEGE FOUNDATION INC
Other - Org Name:MOODY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF ADMIN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-487-1170
Mailing Address - Street 1:5912 SPENCER HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505
Mailing Address - Country:US
Mailing Address - Phone:281-487-1501
Mailing Address - Fax:281-487-6768
Practice Address - Street 1:5912 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:281-487-1501
Practice Address - Fax:281-487-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081662101Medicaid
TX00B025Medicare PIN