Healthcare Provider Details

I. General information

NPI: 1487953345
Provider Name (Legal Business Name): BENJAMIN M MESHACK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 SOUTHWEST FWY
HOUSTON TX
77031-3602
US

IV. Provider business mailing address

11100 SOUTHWEST FWY
HOUSTON TX
77031-3602
US

V. Phone/Fax

Practice location:
  • Phone: 713-771-2225
  • Fax: 713-771-1876
Mailing address:
  • Phone: 713-771-2225
  • Fax: 713-771-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11658
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number11658
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number11658
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number11658
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number11658
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number11658
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number11658
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number11658
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number11658
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number11658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: