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General NPI Number Information
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NPI Number | 1003100660
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Entity Type | Organization
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Legal Business Name | NISAL CORP.
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 10934 EAST FWY
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City | HOUSTON
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State | TX
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Zip | 77029-1959
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Country | US
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Telephone | 713-450-2838
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Fax | 713-450-2843
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Provider Business Mailing Address
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Address Line | PO BOX 24809
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City | HOUSTON
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State | TX
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Zip | 77229-4809
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Country | US
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Telephone | 713-378-0667
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Fax | 713-300-9990
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MS. CARMEN L. MANZO
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Credential |
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Telephone | 713-378-0667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9330
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 9330
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License Number State | TX
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