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General NPI Number Information
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NPI Number | 1780124859
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Entity Type | Organization
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Legal Business Name | FRIENDSWOOD FOREVER WELL LLC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 306 S FRIENDSWOOD DR STE D
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-3982
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Country | US
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Telephone | 281-993-0464
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Fax | 281-993-0565
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Provider Business Mailing Address
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Address Line | 306 S FRIENDSWOOD DR STE D
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-3982
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Country | US
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Telephone | 281-993-0464
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Fax | 281-993-0565
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Authorized Official
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Title or Position | FACILITY OWNER
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Name | MS. JOANNA GRYSZKIEWICZ
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Credential |
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Telephone | 281-993-0464
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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 | 13392
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License Number State | TX
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