MEDICARE: CONVERSE HEALING MINISTRIES TRUST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1144981234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVERSE HEALING MINISTRIES TRUST

Provider Business Mailing Address
First Line	:	8014 KITTY HAWK RD
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2424
Country	:	US
Telephone Number	:	712-223-8692
Fax Number	:

Provider Business Practice Location Address
First Line	:	8014 KITTY HAWK RD
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2424
Country	:	US
Telephone Number	:	210-658-6000
Fax Number	:	210-658-6843

Authorized Official
Title or Position	:	TRUSTEE
Name	:	GERALD J GALVIN
Credential	:	DC
Telephone Number	:	712-223-8692

Provider Enumeration Date	:	01/01/2022
Last Update Date	:	01/01/2022

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Directions to “CONVERSE HEALING MINISTRIES TRUST ” Practice Location

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