=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649784653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDE DANIEL D'SOUZA DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2017
-----------------------------------------------------
Last Update Date | 11/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11811 NORTH FWY STE 610
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77060-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-999-5252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 602 RIVER DELTA LN
-----------------------------------------------------
City | ROSENBERG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-5790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-876-5795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 11303
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------