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General NPI Number Information
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NPI Number | 1992905988
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Entity Type | Organization
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Legal Business Name | MUSCLE MANAGEMENT, P.C.
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 16151 CAIRNWAY DR STE NO.100
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City | HOUSTON
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State | TX
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Zip | 77084-3550
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Country | US
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Telephone | 281-345-2344
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Fax | 281-345-2377
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Provider Business Mailing Address
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Address Line | 16151 CAIRNWAY DR STE NO.100
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City | HOUSTON
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State | TX
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Zip | 77084-3550
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Country | US
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Telephone | 281-345-2344
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Fax | 281-345-2377
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Authorized Official
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Title or Position | CHIROPRACATOR
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Name | DR. ISAAC SIMEON VANDYKEN
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Credential | D.C.
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Telephone | 281-345-2344
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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 | 10178
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License Number State | TX
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