MEDICARE: MR. GILBERTO VENTURA BURGOS

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	8571	TX

General Provider Information

NPI Number	:	1205020492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GILBERTO VENTURA BURGOS

Provider Business Mailing Address
First Line	:	2909 HILLCROFT ST # 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 HILLCROFT ST # 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5847
Country	:	US
Telephone Number	:	281-799-8786
Fax Number	:

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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