MEDICARE: DR. RAYMOND KEITH GLASS 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	4444	TX

General Provider Information

NPI Number	:	1538116090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND KEITH GLASS D.C.

Provider Business Mailing Address
First Line	:	1740 W 27TH ST
Second Line	:	SUITE 221
City	:	HOUSTON
State	:	TX
Zip	:	77008-1440
Country	:	US
Telephone Number	:	713-227-2222
Fax Number	:	713-227-7359

Provider Business Practice Location Address
First Line	:	1740 W 27TH ST
Second Line	:	SUITE 221
City	:	HOUSTON
State	:	TX
Zip	:	77008-1440
Country	:	US
Telephone Number	:	713-227-2222
Fax Number	:	713-227-7359

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	07/08/2007

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