Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6673 | TX |
N | 111NN1001X | Nutrition | 6673 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 6673 | TX |
NPI | 1356534630 |
---|---|
Provider Name | Dr. Ursula D. Funderburk |
First Address | Houston, TX 77231-1473 |
Second Address | Houston, TX 77081-4647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 21/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U62564 | (02) | TX |