Provider Demographics
NPI:1699147090
Name:TESTIMONIAL SPINE & FITNESS, LLC
Entity type:Organization
Organization Name:TESTIMONIAL SPINE & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JULIO
Authorized Official - Last Name:BRANKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-580-9743
Mailing Address - Street 1:6122 GLADEWELL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1502
Mailing Address - Country:US
Mailing Address - Phone:832-580-9743
Mailing Address - Fax:
Practice Address - Street 1:6363 RICHMOND AVE STE 260
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5950
Practice Address - Country:US
Practice Address - Phone:832-580-9743
Practice Address - Fax:832-201-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y7Y9OtherBLUE CROSS BLUE SHIELD OF TEXAS