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General NPI Number Information
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NPI Number | 1780184507
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Entity Type | Organization
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Legal Business Name | MY SPORT CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 6370 N ELDRIDGE PKWY STE C
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City | HOUSTON
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State | TX
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Zip | 77041-3517
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Country | US
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Telephone | 281-556-5200
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Fax | 281-556-5251
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Provider Business Mailing Address
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Address Line | 6370 N ELDRIDGE PKWY STE C
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City | HOUSTON
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State | TX
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Zip | 77041-3517
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Country | US
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Telephone | 281-556-5200
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Fax | 281-556-5251
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BABUSH FARIDI
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Credential | DC
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Telephone | 281-556-5200
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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 | 10305
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License Number State | TX
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