MEDICARE: COLONIES NORTH CHIROPRACTIC CLINIC

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	8684	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0076MS	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245412899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIES NORTH CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	3740 COLONY DR
Second Line	:	SUITE 150
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2234
Country	:	US
Telephone Number	:	210-699-8153
Fax Number	:	210-699-8299

Provider Business Practice Location Address
First Line	:	3740 COLONY DR
Second Line	:	SUITE 150
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2234
Country	:	US
Telephone Number	:	210-699-8153
Fax Number	:	210-699-8299

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY M FENTON JR.
Credential	:	DC
Telephone Number	:	210-699-8153

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	06/19/2008

Similar Medicare Providers

1760472682 — DR. LOUIS HECTOR ESQUIVEL MD
Practice Location Address:

3740 COLONY DR , SUITE LL102
SAN ANTONIO, TX
78230-2234

Practice Phone: 210-745-0918
Practice Fax: 210-745-0590

1679598106 — LARRY M FENTON JR. DC
Practice Location Address:

3740 COLONY DR , SUITE 150
SAN ANTONIO, TX
78230-2234

Practice Phone: 210-699-8153
Practice Fax: 210-699-8299

1417125816 — DR. DANIEL G ARREDONDO DDS
Practice Location Address:

3740 COLONY DR , SUITE 254
SAN ANTONIO, TX
78230-2234

Practice Phone: 210-690-5170
Practice Fax: 210-690-8522

1356578827 — JUANITA A. ARREDONDO LPC-S
Practice Location Address:

3740 COLONY DR. #122
SAN ANTONIO, TX
78230-2234

Practice Phone: 210-846-1091
Practice Fax: 210-541-0173

1518280387 — LOUIS ESQUIVEL MD PA
Practice Location Address:

3740 COLONY DR , SUITE 280
SAN ANTONIO, TX
78230-2234

Practice Phone: 210-745-0918
Practice Fax:

1861794455 — WILLIAM GEORGE BROWN LPC
Practice Location Address:

3740 COLONY DR
SAN ANTONIO, TX
78230-2234

Practice Phone: 210-488-4094
Practice Fax:

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