=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811385529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANEW CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2015
-----------------------------------------------------
Last Update Date | 01/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6318 FM 1488 RD SUITE 110
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77354-2763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-273-3370
-----------------------------------------------------
Fax | 936-273-3371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6318 FM 1488 RD SUITE 110
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77354-2763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-273-3370
-----------------------------------------------------
Fax | 936-273-3371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | YAEL GURWITZ-ELKIN
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 936-273-3370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 12438
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------