MEDICARE: MAGNOLIA CHIROPRACTIC CLINIC, INC.

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	DC4643	TX

General Provider Information

NPI Number	:	1316062292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	1212 CROSSTIMBERS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3910
Country	:	US
Telephone Number	:	713-923-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 CROSSTIMBERS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3910
Country	:	US
Telephone Number	:	713-923-4000
Fax Number	:

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. SILVIO BRUNA
Credential	:	D.C.
Telephone Number	:	713-923-4000

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/25/2008

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