MEDICARE: NORTH SIDE PAIN RELIEF CENTER, INC

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	9828	TX

General Provider Information

NPI Number	:	1649283508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SIDE PAIN RELIEF CENTER, INC

Provider Business Mailing Address
First Line	:	123 NORTHPOINT DR
Second Line	:	STE 170
City	:	HOUSTON
State	:	TX
Zip	:	77060-3228
Country	:	US
Telephone Number	:	281-445-6944
Fax Number	:	281-445-8009

Provider Business Practice Location Address
First Line	:	123 NORTHPOINT DR
Second Line	:	STE 170
City	:	HOUSTON
State	:	TX
Zip	:	77060-3228
Country	:	US
Telephone Number	:	281-445-6944
Fax Number	:	281-445-8009

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LONNIE NGUYEN
Credential	:
Telephone Number	:	713-652-0011

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/08/2012

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