MEDICARE: STUART BROOKS HOLIFIELD III 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	111NR0400X	Rehabilitation Chiropractor	10657	TX

General Provider Information

NPI Number	:	1770780785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART BROOKS HOLIFIELD III D.C.

Provider Business Mailing Address
First Line	:	3910 FAIRMONT PKWY # 321
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3076
Country	:	US
Telephone Number	:	832-264-5425
Fax Number	:	713-468-1830

Provider Business Practice Location Address
First Line	:	1160 BLALOCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7421
Country	:	US
Telephone Number	:	713-468-1272
Fax Number	:	179-980-3905

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/08/2007

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