Healthcare Provider Details

I. General information

NPI: 1740053552
Provider Name (Legal Business Name): OMNI HEALTH CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17102 HIGHWAY 46 W STE 14
SPRING BRANCH TX
78070-7120
US

IV. Provider business mailing address

17102 HIGHWAY 46 W STE 14
SPRING BRANCH TX
78070-7120
US

V. Phone/Fax

Practice location:
  • Phone: 830-214-2211
  • Fax:
Mailing address:
  • Phone: 830-214-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JORDAN MASSO
Title or Position: OWNER/CHIROPRACTOR
Credential:
Phone: 956-605-3762