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General NPI Number Information
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NPI Number | 1811393200
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Entity Type | Organization
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Legal Business Name | ALPHA/OMEGA CHIROPRACTIC & WELLNESS UTOPIA
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 2101 CRAWFORD ST STE 207
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City | HOUSTON
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State | TX
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Zip | 77002-8941
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Country | US
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Telephone | 346-444-5225
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Fax | 346-444-5224
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Provider Business Mailing Address
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Address Line | 2101 CRAWFORD ST STE 207
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City | HOUSTON
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State | TX
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Zip | 77002-8941
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Country | US
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Telephone | 346-444-5225
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Fax | 346-444-5224
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Authorized Official
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Title or Position | PA/CEO
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Name | CARROLL GREEN
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Credential | PA
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Telephone | 832-969-6744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PA03050
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License Number State | TX
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