=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396868899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCARSDALE CHIROPRACTIC REHAB PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10904 SCARSDALE BLVD SUITE 258
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-481-6170
-----------------------------------------------------
Fax | 281-481-6178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10904 SCARSDALE BLVD SUITE 258
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-481-6170
-----------------------------------------------------
Fax | 281-481-6178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER CHIROPRACTOR
-----------------------------------------------------
Name | DR. RICHARD D HOANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-481-6170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8252
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------