MEDICARE: ACCIDENT BENEFIT 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	F007340	TX

General Provider Information

NPI Number	:	1922256932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCIDENT BENEFIT CLINICS LLC

Provider Business Mailing Address
First Line	:	5835 CALLAGHAN RD
Second Line	:	SUITE 209
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1125
Country	:	US
Telephone Number	:	210-684-1600
Fax Number	:	210-684-1601

Provider Business Practice Location Address
First Line	:	5835 CALLAGHAN RD
Second Line	:	SUITE 209
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1125
Country	:	US
Telephone Number	:	210-684-1600
Fax Number	:	210-684-1601

Authorized Official
Title or Position	:	OWNER
Name	:	MISS ANGELIFE PARDO
Credential	:
Telephone Number	:	210-684-1600

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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