MEDICARE: DR. LARA CLINTON 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	6341	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6341	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1265525554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARA CLINTON D.C.

Provider Business Mailing Address
First Line	:	4654 HIGHWAY 6 N
Second Line	:	SUITE 305
City	:	HOUSTON
State	:	TX
Zip	:	77084-2868
Country	:	US
Telephone Number	:	281-855-2277
Fax Number	:	281-855-2292

Provider Business Practice Location Address
First Line	:	4654 HIGHWAY 6 N
Second Line	:	SUITE 305
City	:	HOUSTON
State	:	TX
Zip	:	77084-2868
Country	:	US
Telephone Number	:	281-855-2277
Fax Number	:	281-855-2292

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	12/08/2010

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