Healthcare Provider Details

I. General information

NPI: 1326559956
Provider Name (Legal Business Name): TWENTY ONE RECOVERY AND CONSULT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 VISTA RD
PASADENA TX
77504-2117
US

IV. Provider business mailing address

2143 HAWTHORNE BROOK LN
FRESNO TX
77545-6080
US

V. Phone/Fax

Practice location:
  • Phone: 281-989-9419
  • Fax:
Mailing address:
  • Phone: 281-989-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY R. SUEING SR.
Title or Position: CEO
Credential: OFFICER
Phone: 281-989-9419