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General NPI Number Information
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NPI Number | 1659657484
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC SPORTS THERAPY & WELLNESS CENTER
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 11200 BROADWAY ST STE 2743
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City | PEARLAND
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State | TX
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Zip | 77584-9785
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Country | US
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Telephone | 832-895-6620
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Fax | 832-436-2793
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Provider Business Mailing Address
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Address Line | 11200 BROADWAY ST STE 2743
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City | PEARLAND
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State | TX
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Zip | 77584-9785
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Country | US
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Telephone | 832-895-6620
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Fax | 832-436-2793
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Authorized Official
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Title or Position | CHIROPRACTIC
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Name | DR. REBEKAH CHRISTEN WHITE
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Credential | D.C.
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Telephone | 832-736-8863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 10748
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10751
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License Number State | TX
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