Provider Demographics
NPI:1124270798
Name:MEMORIAL CHIROPRACTIC CLINIC, INC
Entity type:Organization
Organization Name:MEMORIAL CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-467-5367
Mailing Address - Street 1:12421 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-6131
Mailing Address - Country:US
Mailing Address - Phone:713-467-5367
Mailing Address - Fax:713-467-0937
Practice Address - Street 1:12421 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-6131
Practice Address - Country:US
Practice Address - Phone:713-467-5367
Practice Address - Fax:713-467-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31EMOtherBLUE CROSS BLUE SHIELD