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General NPI Number Information
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NPI Number | 1669088514
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Entity Type | Organization
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Legal Business Name | SWAG WELL1 LLC
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 1417 FM 1463 RD STE 140
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City | KATY
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State | TX
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Zip | 77494-5456
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Country | US
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Telephone | 832-437-3414
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Fax | 832-201-7272
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Provider Business Mailing Address
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Address Line | 1417 FM 1463 RD STE 140
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City | KATY
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State | TX
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Zip | 77494-5456
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Country | US
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Telephone | 832-437-3414
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Fax | 832-201-7272
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANE SIGG
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Credential | DC
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Telephone | 832-437-3414
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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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