Provider Demographics
NPI:1386070183
Name:PROCHIROPRACTIC REHABILITATION CORP.
Entity type:Organization
Organization Name:PROCHIROPRACTIC REHABILITATION CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-203-6070
Mailing Address - Street 1:22560 SH249
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1557
Mailing Address - Country:US
Mailing Address - Phone:832-761-7217
Mailing Address - Fax:832-761-7218
Practice Address - Street 1:22560 SH249
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1557
Practice Address - Country:US
Practice Address - Phone:832-761-7217
Practice Address - Fax:832-761-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9580261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty