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General NPI Number Information
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NPI Number | 1174049159
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Entity Type | Organization
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Legal Business Name | FECF, LLC
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 15502 GALVESTON ROAD #207
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City | HOUSTON
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State | TX
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Zip | 77598-7759
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Country | US
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Telephone | 281-607-3043
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W TEXAS AVE 416
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City | WEBSTER
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State | TX
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Zip | 77598-3280
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Country | US
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Telephone | 518-542-9371
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. KATHERINE VAN WAGENEN
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Credential | DC
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Telephone | 518-542-9371
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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 | 12705
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License Number State | TX
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