Provider Demographics
NPI:1902158199
Name:TEXAS SPINE AND JOINT REHABILITATION
Entity Type:Organization
Organization Name:TEXAS SPINE AND JOINT REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-675-0500
Mailing Address - Street 1:1401 THORPE LN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6541
Mailing Address - Country:US
Mailing Address - Phone:512-392-3900
Mailing Address - Fax:512-392-9939
Practice Address - Street 1:1401 THORPE LN
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6541
Practice Address - Country:US
Practice Address - Phone:512-392-3900
Practice Address - Fax:512-392-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty