MEDICARE: TEXAS CHIROPRACTIC & SPORTS MEDICINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	111NN1001X	Nutrition Chiropractor
3	111NS0005X	Sports Physician Chiropractor
4	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1699069427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CHIROPRACTIC & SPORTS MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	3000 WESLAYAN ST STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5739
Country	:	US
Telephone Number	:	713-621-8341
Fax Number	:	713-877-9457

Provider Business Practice Location Address
First Line	:	3000 WESLAYAN ST STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5739
Country	:	US
Telephone Number	:	713-621-8341
Fax Number	:	713-877-9457

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK ALLEN DENNIS
Credential	:	D.C.
Telephone Number	:	713-621-8341

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	06/09/2011

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