Provider Demographics
NPI:1194065581
Name:BORNE-NUSOM, ALICIA M (DC)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:M
Last Name:BORNE-NUSOM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:BORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5512 RIO ALAMO ST
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4002
Mailing Address - Country:US
Mailing Address - Phone:240-779-1203
Mailing Address - Fax:
Practice Address - Street 1:9896 BISSONNET ST STE 133
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8104
Practice Address - Country:US
Practice Address - Phone:240-779-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor