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General NPI Number Information
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NPI Number | 1114334513
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Entity Type | Organization
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Legal Business Name | ST JOHNS NERVE AND JOINT
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 5403 BISSONNET ST SUITE A
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City | HOUSTON
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State | TX
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Zip | 77081-6605
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Country | US
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Telephone | 832-620-8905
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Fax |
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Provider Business Mailing Address
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Address Line | 17811 VINTAGE WOOD LN
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City | SPRING
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State | TX
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Zip | 77379-3932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. RODRIGO DANIEL HINKE
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Credential | D.C., A.P.R.N.
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Telephone | 832-620-8905
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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 | 11514
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP123945
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License Number State | TX
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