Provider Demographics
NPI:1861247702
Name:SOMA LABS, LLC
Entity type:Organization
Organization Name:SOMA LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-208-7229
Mailing Address - Street 1:4227 S MAIN ST STE 13
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5309
Mailing Address - Country:US
Mailing Address - Phone:281-208-7229
Mailing Address - Fax:281-377-1390
Practice Address - Street 1:4227 S MAIN ST STE 13
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5309
Practice Address - Country:US
Practice Address - Phone:281-208-7229
Practice Address - Fax:281-377-1390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMA LAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty