Healthcare Provider Details

I. General information

NPI: 1104064674
Provider Name (Legal Business Name): PLATINUM NEURO DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 MEMORIAL DR SUITE F #414
HOUSTON TX
77007-8021
US

IV. Provider business mailing address

5535 MEMORIAL DR SUITE F #414
HOUSTON TX
77007-8021
US

V. Phone/Fax

Practice location:
  • Phone: 409-833-9505
  • Fax: 409-833-9525
Mailing address:
  • Phone: 409-833-9505
  • Fax: 409-833-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number6932
License Number StateTX

VIII. Authorized Official

Name: CRAIG A THIRY
Title or Position: OWNER/PROVIDER
Credential: DC
Phone: 409-833-9505