MEDICARE: HEAVEN LONDOT D.C.

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	13337	TX

General Provider Information

NPI Number	:	1194265025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEAVEN LONDOT D.C.

Provider Business Mailing Address
First Line	:	420 JOHNSON RD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 JOHNSON RD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3460
Country	:	US
Telephone Number	:	817-431-4242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2017
Last Update Date	:	02/25/2017

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Directions to “ HEAVEN LONDOT D.C.” Practice Location

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