Healthcare Provider Details

I. General information

NPI: 1275719080
Provider Name (Legal Business Name): 290 PAIN & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 NORTHWEST FWY STE 115
HOUSTON TX
77092-7309
US

IV. Provider business mailing address

10900 NORTHWEST FWY STE 115
HOUSTON TX
77092-7309
US

V. Phone/Fax

Practice location:
  • Phone: 713-290-1881
  • Fax: 713-290-1616
Mailing address:
  • Phone: 713-290-1881
  • Fax: 713-290-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateTX

VIII. Authorized Official

Name: THAO T HUYNH
Title or Position: VICE PRESIDENT
Credential: D.C.
Phone: 713-290-1881