=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336239334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED CHIROPRACTIC & MASSAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 08/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9888 BISSONNET ST STE 530
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-981-9505
-----------------------------------------------------
Fax | 713-981-5825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9888 BISSONNET ST STE 530
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-981-9505
-----------------------------------------------------
Fax | 713-981-5825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. IHEOMA C ABRAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-304-5851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | D.C. 8742
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------