Provider Demographics
NPI:1780705111
Name:DYNAMIC CHIROPRACTIC CLINIC, INC
Entity type:Organization
Organization Name:DYNAMIC CHIROPRACTIC CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYDARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-933-6363
Mailing Address - Street 1:8145 HIGHWAY 6 S
Mailing Address - Street 2:SUITE 138
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5763
Mailing Address - Country:US
Mailing Address - Phone:281-933-6363
Mailing Address - Fax:281-933-8949
Practice Address - Street 1:8145 HIGHWAY 6 S
Practice Address - Street 2:SUITE 138
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5763
Practice Address - Country:US
Practice Address - Phone:281-933-6363
Practice Address - Fax:281-933-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0040HSOtherBLUE CORSS BLUE SHIELD
8G3870OtherBC BS PROVIDER
U87666Medicare UPIN
TX0040HSOtherBLUE CORSS BLUE SHIELD