Provider Demographics
NPI:1124371893
Name:MUKORO, NELSON EMMANUEL (DC)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:EMMANUEL
Last Name:MUKORO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 FIR CREST CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6006
Mailing Address - Country:US
Mailing Address - Phone:713-419-1148
Mailing Address - Fax:713-667-5712
Practice Address - Street 1:2600 S LOOP W STE 580
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2604
Practice Address - Country:US
Practice Address - Phone:713-419-1148
Practice Address - Fax:713-667-5712
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor