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General NPI Number Information
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NPI Number | 1376806919
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Entity Type | Organization
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Legal Business Name | WHOLESOME LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 5925 ALMEDA RD FL 6
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City | HOUSTON
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State | TX
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Zip | 77004-7602
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Country | US
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Telephone | 832-741-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 3375 WESTPARK DR # 314
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City | HOUSTON
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State | TX
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Zip | 77005-4262
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Country | US
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Telephone | 832-741-3391
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIVA LORAINE DAVIS
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Credential | D.C.
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Telephone | 832-741-3391
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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 | 12045
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License Number State | TX
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