MEDICARE: HEALTHSOURCE CLINICS, 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	111NR0400X	Rehabilitation Chiropractor	10605	TX

General Provider Information

NPI Number	:	1598069080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSOURCE CLINICS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 842079
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77284-2079
Country	:	US
Telephone Number	:	281-858-4446
Fax Number	:	281-858-4459

Provider Business Practice Location Address
First Line	:	8925 HIGHWAY 6 N
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77095-2457
Country	:	US
Telephone Number	:	281-858-4446
Fax Number	:	281-858-4459

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAMMY TAO
Credential	:	D.C.
Telephone Number	:	281-858-4446

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	12/27/2010

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