Provider Demographics
NPI:1487973301
Name:HEALTHSOURCE OF KINGWOOD
Entity type:Organization
Organization Name:HEALTHSOURCE OF KINGWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-858-4446
Mailing Address - Street 1:15498 FM 529
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:281-858-4446
Mailing Address - Fax:281-858-4459
Practice Address - Street 1:2316 TIMBER SHADOWS DR
Practice Address - Street 2:#1025
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2026
Practice Address - Country:US
Practice Address - Phone:281-358-8585
Practice Address - Fax:281-358-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty