Provider Demographics
NPI:1588165179
Name:INTEGRATIVE SPINE AND JOINT ASSOCIATES LLC
Entity type:Organization
Organization Name:INTEGRATIVE SPINE AND JOINT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ELDOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-647-5284
Mailing Address - Street 1:7505 FANNIN ST STE 350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1954
Mailing Address - Country:US
Mailing Address - Phone:832-647-5284
Mailing Address - Fax:713-456-2416
Practice Address - Street 1:7505 FANNIN ST
Practice Address - Street 2:350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1954
Practice Address - Country:US
Practice Address - Phone:832-647-5284
Practice Address - Fax:713-456-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5593261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5593OtherTEXAS MEDICAL BOARD