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General NPI Number Information
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NPI Number | 1053451864
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Entity Type | Organization
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Legal Business Name | INNOVATIVE NEURO SPINE INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9898 BISSONNET # 152
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City | HOUSTON
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State | TX
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Zip | 77036-8025
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Country | US
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Telephone | 713-271-7373
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Fax | 713-271-2219
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Provider Business Mailing Address
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Address Line | 9898 BISSONNET # 152
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City | HOUSTON
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State | TX
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Zip | 77036-8025
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Country | US
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Telephone | 713-271-7373
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Fax | 713-271-2219
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Authorized Official
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Title or Position | DOCTOR
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Name | MAHMOOD PRUSHESH
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Credential | DC
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Telephone | 713-271-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 8473
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License Number State | TX
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