MEDICARE: GULF COAST CLINIC OF CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1124644943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST CLINIC OF CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2825 NASA PKWY
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586-3215
Country	:	US
Telephone Number	:	281-532-3160
Fax Number	:	281-532-3480

Provider Business Practice Location Address
First Line	:	2825 NASA PKWY
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586-3215
Country	:	US
Telephone Number	:	281-532-3160
Fax Number	:	281-532-3480

Authorized Official
Title or Position	:	DOCTOR
Name	:	MARK HILL
Credential	:	DC
Telephone Number	:	281-532-3160

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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Directions to “GULF COAST CLINIC OF CHIROPRACTIC LLC ” Practice Location

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