Provider Demographics
NPI:1598069080
Name:HEALTHSOURCE CLINICS, LLC
Entity type:Organization
Organization Name:HEALTHSOURCE CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:PO BOX 842079
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77284-2079
Mailing Address - Country:US
Mailing Address - Phone:281-858-4446
Mailing Address - Fax:281-858-4459
Practice Address - Street 1:8925 HIGHWAY 6 N
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2457
Practice Address - Country:US
Practice Address - Phone:281-858-4446
Practice Address - Fax:281-858-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10605111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU95413Medicare UPIN