Provider Demographics
NPI:1992905988
Name:MUSCLE MANAGEMENT, P.C.
Entity type:Organization
Organization Name:MUSCLE MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:SIMEON
Authorized Official - Last Name:VANDYKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-345-2344
Mailing Address - Street 1:16151 CAIRNWAY DR STE NO.100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3550
Mailing Address - Country:US
Mailing Address - Phone:281-345-2344
Mailing Address - Fax:281-345-2377
Practice Address - Street 1:16151 CAIRNWAY DR STE NO.100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3550
Practice Address - Country:US
Practice Address - Phone:281-345-2344
Practice Address - Fax:281-345-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022KBOtherMAJOR HEALTH INSURANCE