MEDICARE: DR. ROBERT ELLIOTT CANAL 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	6276	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8S1120	OTHER	TX	BCBS NUMBER

General Provider Information

NPI Number	:	1508896408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ELLIOTT CANAL D.C.

Provider Business Mailing Address
First Line	:	1706 PINE GAP DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2359
Country	:	US
Telephone Number	:	713-894-3623
Fax Number	:	281-919-1466

Provider Business Practice Location Address
First Line	:	1706 PINE GAP DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2359
Country	:	US
Telephone Number	:	713-894-3623
Fax Number	:	281-919-1466

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	12/20/2019

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