Provider Demographics
NPI:1447502935
Name:SE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:SE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALEXANDER GENSON
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-667-5190
Mailing Address - Street 1:6006 BELLAIRE BLVD SUITE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081
Mailing Address - Country:US
Mailing Address - Phone:713-667-5198
Mailing Address - Fax:
Practice Address - Street 1:6006 BELLAIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5439
Practice Address - Country:US
Practice Address - Phone:713-667-5198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty