MEDICARE: PAIN RELIEF MEDICAL CLINIC

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	111NR0400X	Rehabilitation Chiropractor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		WILL NOT BE AFFILIATED WITH MEDICARE OR MEDICAID

General Provider Information

NPI Number	:	1346799749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN RELIEF MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	4625 NORTH FWY STE 221
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-2930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4625 NORTH FWY STE 221
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-2930
Country	:	US
Telephone Number	:	281-677-6788
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISABEL SOSA
Credential	:
Telephone Number	:	832-858-6616

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	09/26/2016

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Directions to “PAIN RELIEF MEDICAL CLINIC ” Practice Location

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