MEDICARE: NISAL CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9330	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	9330	TX

General Provider Information

NPI Number	:	1003100660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NISAL CORP.

Provider Business Mailing Address
First Line	:	PO BOX 24809
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77229-4809
Country	:	US
Telephone Number	:	713-378-0667
Fax Number	:	713-300-9990

Provider Business Practice Location Address
First Line	:	10934 EAST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-1959
Country	:	US
Telephone Number	:	713-450-2838
Fax Number	:	713-450-2843

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MS. CARMEN L. MANZO
Credential	:
Telephone Number	:	713-378-0667

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	12/15/2011

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Directions to “NISAL CORP. ” Practice Location

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