=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306662135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M.M.K.E LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2024
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30340 FM 2978 RD STE 600
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77354-6152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-335-9990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8136 ROSEMARY SAGE DR
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77354-4150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-335-9990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. MARIAM MAHMOUD MOBARAK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 832-335-9990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------