MEDICARE: DR. URSULA D. FUNDERBURK DC

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	6673	TX
2	111NN1001X	Nutrition Chiropractor	6673	TX
3	111NR0400X	Rehabilitation Chiropractor	6673	TX

General Provider Information

NPI Number	:	1356534630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. URSULA D. FUNDERBURK DC

Provider Business Mailing Address
First Line	:	PO BOX 31473
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77231-1473
Country	:	US
Telephone Number	:	832-282-0458
Fax Number	:	713-665-9677

Provider Business Practice Location Address
First Line	:	6550 MAPLERIDGE ST STE 222
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4647
Country	:	US
Telephone Number	:	713-665-9675
Fax Number	:	713-665-9677

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

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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