Provider Demographics
NPI:1215315270
Name:SPINE & SPORTS THERAPY KINGWOOD, LP
Entity type:Organization
Organization Name:SPINE & SPORTS THERAPY KINGWOOD, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWALCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP, FIAMA
Authorized Official - Phone:713-629-9200
Mailing Address - Street 1:4295 SAN FELIPE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2942
Mailing Address - Country:US
Mailing Address - Phone:713-629-9200
Mailing Address - Fax:713-513-5048
Practice Address - Street 1:1801 KINGWOOD DR
Practice Address - Street 2:SUITE 180
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3060
Practice Address - Country:US
Practice Address - Phone:713-629-9200
Practice Address - Fax:713-513-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty