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General NPI Number Information
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NPI Number | 1073637260
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Entity Type | Organization
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Legal Business Name | KOALA HEALTH & WELLNESS CENTERS INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 4665 SW FWY #214
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City | HOUSTON
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State | TX
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Zip | 77027
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Country | US
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Telephone | 713-652-9777
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Fax | 713-651-0584
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Provider Business Mailing Address
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Address Line | 4665 SW FWY #214
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City | HOUSTON
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State | TX
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Zip | 77027
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Country | US
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Telephone | 713-652-9777
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Fax | 713-651-0584
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. EDWIN DEAN KIEKE
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Credential | D.C.
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Telephone | 713-652-9777
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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 | F004567
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License Number State | TX
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