MEDICARE: MIDTOWN PAIN AND REHABILITATION CENTER

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	DC8151	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467575415	OTHER	TX	BCBSTX NPI

General Provider Information

NPI Number	:	1356519367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN PAIN AND REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	2117 CHENEVERT ST STE J
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-5845
Country	:	US
Telephone Number	:	713-650-6656
Fax Number	:	713-655-1118

Provider Business Practice Location Address
First Line	:	2117 CHENEVERT ST STE J
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-5845
Country	:	US
Telephone Number	:	713-650-6656
Fax Number	:	713-655-1118

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTOR
Name	:	LAURA T LE
Credential	:
Telephone Number	:	713-650-6656

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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Directions to “MIDTOWN PAIN AND REHABILITATION CENTER ” Practice Location

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