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General NPI Number Information
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NPI Number | 1669941324
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE SPINE AND SPORTS CHIROPRACTIC REHAB PLLC
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Dates
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Enumeration Date | 11/24/2018
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Last Update Date | 11/24/2018
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Provider Practice Location Address
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Address Line | 500 SPRING HILL DR STE 120
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City | SPRING
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State | TX
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Zip | 77386-6024
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Country | US
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Telephone | 832-413-1130
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Fax |
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Provider Business Mailing Address
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Address Line | 8055 CAMBRIDGE ST APT 27
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City | HOUSTON
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State | TX
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Zip | 77054-3030
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Country | US
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Telephone | 832-350-5946
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PT
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Name | GERSHOM JINHYUN KIM
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Credential | DPT
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Telephone | 817-271-4877
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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