=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588944375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONESH FAMILY WELLNESS CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2011
-----------------------------------------------------
Last Update Date | 08/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8561 LONG POINT RD STE 103
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-2397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-465-2422
-----------------------------------------------------
Fax | 713-465-5018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8561 LONG POINT RD STE 103
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-2397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-465-2422
-----------------------------------------------------
Fax | 713-465-5018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. REZA KAVEH DONESH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 713-465-2422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 6538DC
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------