Healthcare Provider Details

I. General information

NPI: 1104545805
Provider Name (Legal Business Name): EMERALD CHIROPRACTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 SOUTHWEST FWY STE 370
HOUSTON TX
77074-1140
US

IV. Provider business mailing address

10101 SOUTHWEST FWY STE 370
HOUSTON TX
77074-1140
US

V. Phone/Fax

Practice location:
  • Phone: 281-973-5889
  • Fax: 281-973-4606
Mailing address:
  • Phone: 281-973-5889
  • Fax: 281-973-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: RONKE ODIGIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-973-5889