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General NPI Number Information
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NPI Number | 1760293708
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Entity Type | Organization
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Legal Business Name | MO CITY CHIROPRACTIC AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 2755 TEXAS PKWY STE 102
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City | MISSOURI CITY
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State | TX
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Zip | 77489-5114
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Country | US
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Telephone | 832-440-7690
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Fax |
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Provider Business Mailing Address
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Address Line | 2755 TEXAS PKWY STE 102
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City | MISSOURI CITY
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State | TX
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Zip | 77489-5114
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Country | US
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Telephone | 832-440-7690
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Fax | 832-440-7693
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Authorized Official
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Title or Position | MANAGER
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Name | SHALONDA ELLIS
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Credential |
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Telephone | 832-440-7690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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