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General NPI Number Information
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NPI Number | 1639333024
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Entity Type | Organization
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Legal Business Name | SOUTH HOUSTON CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 6733 FAIRMONT PKWY
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City | PASADENA
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State | TX
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Zip | 77505-4403
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Country | US
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Telephone | 713-946-7841
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Fax | 281-991-7617
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Provider Business Mailing Address
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Address Line | PO BOX 5238
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City | PASADENA
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State | TX
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Zip | 77508-5238
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Country | US
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Telephone | 713-946-7841
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Fax | 281-991-7617
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CHESS L MILES
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Credential | D.C.
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Telephone | 713-946-7841
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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 | 2586
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License Number State | TX
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