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General NPI Number Information
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NPI Number | 1124270798
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Entity Type | Organization
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Legal Business Name | MEMORIAL CHIROPRACTIC CLINIC, INC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 12421 MEMORIAL DR
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City | HOUSTON
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State | TX
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Zip | 77024-6131
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Country | US
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Telephone | 713-467-5367
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Fax | 713-467-0937
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Provider Business Mailing Address
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Address Line | 12421 MEMORIAL DR
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City | HOUSTON
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State | TX
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Zip | 77024-6131
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Country | US
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Telephone | 713-467-5367
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Fax | 713-467-0937
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Authorized Official
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Title or Position | OWNER
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Name | JACK CHRISTIE
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Credential | D.C.
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Telephone | 713-467-5367
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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 |
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License Number State |
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