Healthcare Provider Details

I. General information

NPI: 1073637260
Provider Name (Legal Business Name): KOALA HEALTH & WELLNESS CENTERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 SW FWY #214
HOUSTON TX
77027
US

IV. Provider business mailing address

4665 SW FWY #214
HOUSTON TX
77027
US

V. Phone/Fax

Practice location:
  • Phone: 713-652-9777
  • Fax: 713-651-0584
Mailing address:
  • Phone: 713-652-9777
  • Fax: 713-651-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF004567
License Number StateTX

VIII. Authorized Official

Name: DR. EDWIN DEAN KIEKE
Title or Position: VICE PRESIDENT
Credential: D.C.
Phone: 713-652-9777