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General NPI Number Information
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NPI Number | 1487216826
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Entity Type | Organization
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Legal Business Name | SOURCE & SPHERE, PLLC
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Dates
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Enumeration Date | 07/06/2019
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Last Update Date | 07/06/2019
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Provider Practice Location Address
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Address Line | 3104 EDLOE ST STE 310
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City | HOUSTON
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State | TX
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Zip | 77027-6038
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Country | US
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Telephone | 281-740-9225
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Fax | 281-715-5317
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Provider Business Mailing Address
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Address Line | 23561 HICKORY DR
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City | PORTER
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State | TX
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Zip | 77365-5217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DANIELLE COCKBURN
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Credential | DC
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Telephone | 281-740-9225
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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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