Provider Demographics
NPI:1679852974
Name:KINGSLAND ADVANCED HEALTH & CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:KINGSLAND ADVANCED HEALTH & CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:SAULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-276-7600
Mailing Address - Street 1:6250 WESTPARK DR STE 319
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7381
Mailing Address - Country:US
Mailing Address - Phone:832-667-8952
Mailing Address - Fax:832-667-8485
Practice Address - Street 1:6250 WESTPARK DR STE 319
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7381
Practice Address - Country:US
Practice Address - Phone:832-667-8952
Practice Address - Fax:832-667-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF009193305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service