Provider Demographics
NPI:1730214560
Name:KIEKE, EDWIN DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:DEAN
Last Name:KIEKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 SW FWY
Mailing Address - Street 2:#214
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-652-9777
Mailing Address - Fax:713-651-0584
Practice Address - Street 1:4665 SW FWY
Practice Address - Street 2:#214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-652-9777
Practice Address - Fax:713-651-0584
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A1790OtherBLUECROSS BLUESHIELD ID
TX5398448OtherCIGNA ID
TX8G0773OtherBLUECROSS BLUESHIELD ID
TX4341235OtherAETNA ID
TX8214198OtherBLUELINK ID
TXU14198Medicare UPIN
TX8A1790OtherBLUECROSS BLUESHIELD ID