Provider Demographics
NPI:1871606020
Name:HOUSTON SPINE & REHABILITATION CENTERS
Entity type:Organization
Organization Name:HOUSTON SPINE & REHABILITATION CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:YEZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-362-0006
Mailing Address - Street 1:3101 COLLEGE PARK DR.
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4099
Mailing Address - Country:US
Mailing Address - Phone:281-362-0006
Mailing Address - Fax:281-362-0233
Practice Address - Street 1:3101 COLLEGE PARK DR.
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4099
Practice Address - Country:US
Practice Address - Phone:281-362-0006
Practice Address - Fax:281-362-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1881668267OtherNPI
TX8F1969Medicare ID - Type Unspecified
TXU62470Medicare UPIN