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General NPI Number Information
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NPI Number | 1750818795
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Entity Type | Organization
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Legal Business Name | SOUTH HOUSTON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 8101 AIRPORT BLVD. STE. A
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City | HOUSTON
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State | TX
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Zip | 77061
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Country | US
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Telephone | 832-916-7642
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Fax | 832-518-1599
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Provider Business Mailing Address
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Address Line | 907 EL DORADO BLVD. STE. B
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City | HOUSTON
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State | TX
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Zip | 77062
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Country | US
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Telephone | 832-916-7642
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Fax | 832-518-1599
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MICHAEL T. MARTIN
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Credential | D.C.
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Telephone | 830-609-8707
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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 | TX
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