Provider Demographics
NPI:1811264294
Name:SPACE CENTER CHIROPRACTIC
Entity type:Organization
Organization Name:SPACE CENTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:SPRECHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-332-1111
Mailing Address - Street 1:425 E NASA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-3400
Mailing Address - Country:US
Mailing Address - Phone:281-334-1111
Mailing Address - Fax:281-333-0523
Practice Address - Street 1:425 E NASA RD 1
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5314
Practice Address - Country:US
Practice Address - Phone:281-334-1111
Practice Address - Fax:281-333-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601986Medicare UPIN