MEDICARE: BENJAMIN BEARD CHIROPRACTIC

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	2335	TX

General Provider Information

NPI Number	:	1629265210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN BEARD CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3815 REVEILLE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4503
Country	:	US
Telephone Number	:	713-649-2201
Fax Number	:	713-643-5521

Provider Business Practice Location Address
First Line	:	3815 REVEILLE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4503
Country	:	US
Telephone Number	:	713-649-2201
Fax Number	:	713-643-5521

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	BENJAMIN BEARD
Credential	:	D.C.
Telephone Number	:	713-649-2201

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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