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General NPI Number Information
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NPI Number | 1649874116
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Entity Type | Organization
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Legal Business Name | CORETECH FITNESS LAB
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 632 CRABBRIVER RD
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City | RICHMOND
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State | TX
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Zip | 77469
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Country | US
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Telephone | 281-545-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 ROGERDALE RD STE 100
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City | HOUSTON
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State | TX
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Zip | 77042-4125
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Country | US
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Telephone | 832-581-2327
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. LENNOX GORDON JR.
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Credential |
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Telephone | 832-581-2327
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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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