Provider Demographics
NPI:1548543291
Name:SOC CHIROPRACTIC SPORTS & WELLNESS
Entity type:Organization
Organization Name:SOC CHIROPRACTIC SPORTS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOVA
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:CHAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-331-7656
Mailing Address - Street 1:125 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-4401
Mailing Address - Country:US
Mailing Address - Phone:281-331-7656
Mailing Address - Fax:
Practice Address - Street 1:125 CEDAR LN
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4401
Practice Address - Country:US
Practice Address - Phone:281-331-7656
Practice Address - Fax:281-331-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center