Healthcare Provider Details
I. General information
NPI: 1104040377
Provider Name (Legal Business Name): BALANCED BODIES CHIROPRACTIC AND KINESIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/12/2007
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8811 WESTHEIMER RD STE 101
HOUSTON TX
77063-3626
US
IV. Provider business mailing address
8811 WESTHEIMER RD STE 101
HOUSTON TX
77063-3626
US
V. Phone/Fax
- Phone: 713-977-0005
- Fax: 713-977-2131
- Phone: 713-977-0005
- Fax: 713-977-2131
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111NN1001X |
| Taxonomy | Nutrition Chiropractor |
| License Number | 6174 |
| License Number State | TX |
VIII. Authorized Official
Name: DR.
THOMAS
E
REEVES
Title or Position: OWNER
Credential: DC
Phone: 713-977-0005