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General NPI Number Information
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NPI Number | 1760655377
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Entity Type | Organization
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Legal Business Name | EXPERIENCE CHIROPRACTIC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 16259 FM 529 RD
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City | HOUSTON
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State | TX
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Zip | 77095-1433
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Country | US
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Telephone | 281-345-4450
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Fax | 281-345-4449
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Provider Business Mailing Address
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Address Line | 16259 FM 529 RD
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City | HOUSTON
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State | TX
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Zip | 77095-1433
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Country | US
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Telephone | 281-345-4450
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Fax | 281-345-4449
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICK MAHAN
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Credential | D.C.
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Telephone | 281-345-4450
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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 | 69340
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License Number State | TX
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