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General NPI Number Information
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NPI Number | 1568707685
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Entity Type | Organization
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Legal Business Name | MCS MEDICAL COSMETIC SOURCE, INC
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 6429 FAIRMONT PKWY
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City | PASADENA
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State | TX
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Zip | 77505-4220
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Country | US
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Telephone | 821-487-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 6429 FAIRMONT PKWY
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City | PASADENA
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State | TX
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Zip | 77505-4220
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Country | US
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Telephone | 821-487-2828
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLY DAVIS
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Credential |
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Telephone | 281-487-2828
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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 | TX
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