MEDICARE: DR. PHUONG MY-LE WOLTER 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	9932	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AB452	OTHER	TX	BLUE CROSS BLUE SHIELD OF

General Provider Information

NPI Number	:	1336190677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONG MY-LE WOLTER D.C.

Provider Business Mailing Address
First Line	:	10001 WESTHEIMER RD STE 2960
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3151
Country	:	US
Telephone Number	:	713-587-0900
Fax Number	:	713-587-0905

Provider Business Practice Location Address
First Line	:	10001 WESTHEIMER RD
Second Line	:	STE 2960
City	:	HOUSTON
State	:	TX
Zip	:	77042-3151
Country	:	US
Telephone Number	:	713-587-0900
Fax Number	:	713-587-0905

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/11/2008

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