Provider Demographics
NPI:1316062292
Name:MAGNOLIA CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:MAGNOLIA CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-923-4000
Mailing Address - Street 1:1212 CROSSTIMBERS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-3910
Mailing Address - Country:US
Mailing Address - Phone:713-923-4000
Mailing Address - Fax:
Practice Address - Street 1:1212 CROSSTIMBERS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3910
Practice Address - Country:US
Practice Address - Phone:713-923-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601879Medicare ID - Type Unspecified
TXU14167Medicare UPIN