=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831559376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPINES & HEALTH CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2016
-----------------------------------------------------
Last Update Date | 02/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1319 FM 1960 RD W SUITE 108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-446-6134
-----------------------------------------------------
Fax | 832-446-6134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1319 FM 1960 RD W SUITE 108
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-446-6134
-----------------------------------------------------
Fax | 832-446-6134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS YUWEI ZHANG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 832-446-6134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 13090
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------