Healthcare Provider Details

I. General information

NPI: 1558536011
Provider Name (Legal Business Name): TRADITIONAL CHINESE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17045 EL CAMINO REAL STE 225
HOUSTON TX
77058-2649
US

IV. Provider business mailing address

17045 EL CAMINO REAL STE. 225
HOUSTON TX
77058-2649
US

V. Phone/Fax

Practice location:
  • Phone: 281-488-6300
  • Fax: 281-480-1959
Mailing address:
  • Phone: 281-488-6300
  • Fax: 281-480-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC 5863
License Number StateTX

VIII. Authorized Official

Name: MRS. LESLIE M GRAHAM
Title or Position: CHIROPRACTOR/ACUPUNTRIST
Credential: MS,DC,LAC
Phone: 281-488-6300