MEDICARE: UPTOWN FAMILY CHIROPRACTIC PC

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	TX7968	TX

General Provider Information

NPI Number	:	1407963283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPTOWN FAMILY CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	5701 WOODWAY DRIVE
Second Line	:	SUITE 225
City	:	HOUSTON
State	:	TX
Zip	:	77057
Country	:	US
Telephone Number	:	713-532-2555
Fax Number	:	713-532-2999

Provider Business Practice Location Address
First Line	:	5701 WOODWAY DRIVE
Second Line	:	SUITE 225
City	:	HOUSTON
State	:	TX
Zip	:	77057
Country	:	US
Telephone Number	:	713-532-2555
Fax Number	:	713-532-2999

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	JASON L BASILE
Credential	:	DC
Telephone Number	:	713-532-2555

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/22/2020

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