Provider Demographics
NPI:1215130174
Name:JACINTO CITY WELLNESS CLINIC PA
Entity type:Organization
Organization Name:JACINTO CITY WELLNESS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-455-4344
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:GALENA PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77547-0503
Mailing Address - Country:US
Mailing Address - Phone:713-455-4344
Mailing Address - Fax:713-455-4247
Practice Address - Street 1:1202 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-2202
Practice Address - Country:US
Practice Address - Phone:713-455-4344
Practice Address - Fax:713-455-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty