Provider Demographics
NPI:1306268081
Name:AXIS SPORT & SPINE, LLC
Entity type:Organization
Organization Name:AXIS SPORT & SPINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WASHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-291-7997
Mailing Address - Street 1:2100 NASA PKWY
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3490
Mailing Address - Country:US
Mailing Address - Phone:281-291-7997
Mailing Address - Fax:281-291-8447
Practice Address - Street 1:2100 NASA PKWY
Practice Address - Street 2:SUITE 101 A
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3490
Practice Address - Country:US
Practice Address - Phone:281-291-7997
Practice Address - Fax:281-291-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty