=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316865249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METAMORPHOSIS SPINE AND SPORT WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2026
-----------------------------------------------------
Last Update Date | 07/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6201 BONHOMME RD STE 362N
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-4424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-441-0266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2614 MILL CREEK DR
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77503-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-441-0266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. MALACHI SERAPHIN-WILLIAMS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 405-441-0266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------