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NPI Code Detail

MEDICARE: DERBONNE CHIROPRACTIC

MEDICARE: DERBONNE CHIROPRACTIC
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
1111N00000XChiropractor7124TX

General Provider Information

NPI Number : 1194055988
Entity Type Code : Organization
Provider Name (Legal Business Name) : DERBONNE CHIROPRACTIC
Provider Business Mailing Address
First Line : 120 HIGHWAY 332 W STE A4
Second Line :
City : LAKE JACKSON
State : TX
Zip : 77566-4017
Country : US
Telephone Number : 979-285-2663
Fax Number : 979-285-2664
Provider Business Practice Location Address
First Line : 120 HIGHWAY 332 W STE A4
Second Line :
City : LAKE JACKSON
State : TX
Zip : 77566-4017
Country : US
Telephone Number : 979-285-2663
Fax Number : 979-285-2664
Authorized Official
Title or Position : OWNER
Name : JOHN RAY DERBONNE
Credential : D.C.
Telephone Number : 979-285-2663
Provider Enumeration Date : 12/30/2009
Last Update Date : 12/30/2009

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Directions to “DERBONNE CHIROPRACTIC ” Practice Location

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