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General NPI Number Information
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NPI Number | 1265856942
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Entity Type | Organization
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Legal Business Name | STAFFORD CHIROPRACTIC SPORTS & WELLNESS
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 2434 S MAIN ST
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City | STAFFORD
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State | TX
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Zip | 77477-5522
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Country | US
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Telephone | 281-499-2424
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Fax | 281-499-6525
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Provider Business Mailing Address
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Address Line | 1367 SUGAR CREEK BLVD
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City | SUGAR LAND
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State | TX
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Zip | 77478-3989
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Country | US
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Telephone | 281-499-2424
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Fax | 281-499-6525
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JESSICA F SIMON
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Credential |
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Telephone | 281-499-2424
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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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