MEDICARE: DR. TONY K TABARESTANI D.C.

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	4143	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81V735	OTHER	TX	BUE CROSS BLUE SHIELD OF
2	769339	OTHER	TX	COVENTRY & FIRST HEALTH

General Provider Information

NPI Number	:	1265483507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY K TABARESTANI D.C.

Provider Business Mailing Address
First Line	:	14770 MEMORIAL DR STE 220
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-5252
Country	:	US
Telephone Number	:	281-493-5535
Fax Number	:	281-493-3353

Provider Business Practice Location Address
First Line	:	6535 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2207
Country	:	US
Telephone Number	:	713-981-8184
Fax Number	:	713-981-8114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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