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General NPI Number Information
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NPI Number | 1841489614
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Entity Type | Organization
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Legal Business Name | ACCUMED MEDISPA,LLC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 333 N RIVERSHIRE DR STE 290
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City | CONROE
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State | TX
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Zip | 77304-3100
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Country | US
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Telephone | 936-441-1104
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Fax | 936-756-3360
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Provider Business Mailing Address
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Address Line | 333 N RIVERSHIRE DR STE 290
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City | CONROE
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State | TX
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Zip | 77304-3100
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Country | US
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Telephone | 936-441-1104
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Fax | 936-756-3360
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL DAVID MAGGIO
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Credential |
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Telephone | 936-441-1104
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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 | 9209
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License Number State | TX
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