=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144576679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABSOLUTE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2012
-----------------------------------------------------
Last Update Date | 10/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6065 HILLCROFT ST SUITE 605
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-1087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-581-3867
-----------------------------------------------------
Fax | 832-649-8438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6065 HILLCROFT ST SUITE 605
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-1087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-581-3867
-----------------------------------------------------
Fax | 832-649-8438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. SUE NO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 713-256-2903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 12054
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------