Healthcare Provider Details

I. General information

NPI: 1679803142
Provider Name (Legal Business Name): SANDRA M HUETE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 KNIGHT RD
HOUSTON TX
77054-3905
US

IV. Provider business mailing address

4026 GLENSHIRE ST
HOUSTON TX
77025-3908
US

V. Phone/Fax

Practice location:
  • Phone: 713-668-2225
  • Fax: 713-668-3616
Mailing address:
  • Phone: 713-668-2225
  • Fax: 713-668-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2509
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2509
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2509
License Number StateTX

VIII. Authorized Official

Name: MRS. SANDRA M HUETE
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 713-668-2225