MEDICARE: TEN13 GROUP, LLC

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	305R00000X	Preferred Provider Organization	12198	TX

General Provider Information

NPI Number	:	1386013803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEN13 GROUP, LLC

Provider Business Mailing Address
First Line	:	9601 KATY FWY
Second Line	:	SUITE 430
City	:	HOUSTON
State	:	TX
Zip	:	77024-1342
Country	:	US
Telephone Number	:	713-533-8786
Fax Number	:	713-573-2798

Provider Business Practice Location Address
First Line	:	9601 KATY FWY
Second Line	:	SUITE 430
City	:	HOUSTON
State	:	TX
Zip	:	77024-1342
Country	:	US
Telephone Number	:	713-533-8786
Fax Number	:	713-573-2798

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC/OWNER
Name	:	DR. SUSANNA PARK
Credential	:	D.C.
Telephone Number	:	713-533-8786

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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