MEDICARE: BACKED BY BLACKMON

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1306580584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACKED BY BLACKMON

Provider Business Mailing Address
First Line	:	2578 MADISON AVE
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17047 EL CAMINO REAL STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2615
Country	:	US
Telephone Number	:	713-321-0506
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RANDI BLACKMON
Credential	:	DC
Telephone Number	:	713-855-2929

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/25/2022

Similar Medicare Providers

1063370476 — DR. XAVIER FERRELL DC
Practice Location Address:

17047 EL CAMINO REAL STE 140
HOUSTON, TX
77058-2615

Practice Phone: 713-321-0506
Practice Fax:

1528701166 — RANDI BLACKMON LIKELY DC
Practice Location Address:

17047 EL CAMINO REAL STE 140
HOUSTON, TX
77058-2615

Practice Phone: 713-321-0506
Practice Fax:

1952182685 — NPRESSIONS HAIR COLLECTION
Practice Location Address:

17047 EL CAMINO REAL STE 120
HOUSTON, TX
77058-2615

Practice Phone: 225-485-5075
Practice Fax:

1619972080 — DR. FARNAM H FARZAM M.S., D.D.S.,P.A.
Practice Location Address:

2615 SOUTHWEST FWY , STE 190
HOUSTON, TX
77098-4609

Practice Phone: 713-871-8800
Practice Fax:

1609861343 — SALLY FLEMING SHU MD
Practice Location Address:

17070 RED OAK DR , STE 205
HOUSTON, TX
77090-2615

Practice Phone: 281-440-0734
Practice Fax: 281-440-8065

1154303931 — DR. FRANCIS M BONNER III MD
Practice Location Address:

17070 RED OAK DR , STE 205
HOUSTON, TX
77090-2615

Practice Phone: 281-440-0734
Practice Fax: 281-440-8065

Directions to “BACKED BY BLACKMON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.