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General NPI Number Information
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NPI Number | 1609181296
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL WELLNESS CENTERS, LLC
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 1416 CAMPBELL RD 100
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City | HOUSTON
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State | TX
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Zip | 77055-4752
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Country | US
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Telephone | 832-358-2225
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Fax | 832-358-2226
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Provider Business Mailing Address
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Address Line | 1416 CAMPBELL RD 100
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City | HOUSTON
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State | TX
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Zip | 77055-4752
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Country | US
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Telephone | 832-358-2225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUHYUN AN
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Credential | D.C.
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Telephone | 832-358-2225
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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 | 9783
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License Number State | TX
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