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General NPI Number Information
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NPI Number | 1275822769
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Entity Type | Organization
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Legal Business Name | TEJAS SPINE AND REHAB LLC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 3222 BURKE RD SUITE 104
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City | PASADENA
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State | TX
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Zip | 77504-1859
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Country | US
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Telephone | 832-767-2538
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Fax | 832-767-2562
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Provider Business Mailing Address
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Address Line | 3222 BURKE RD SUITE 104
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City | PASADENA
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State | TX
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Zip | 77504-1859
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Country | US
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Telephone | 832-767-2538
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Fax | 832-767-2562
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN MICHAEL RAIMONDO
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Credential | DC
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Telephone | 832-767-2538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 8322
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License Number State | TX
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