MEDICARE: CONSTANTINE S PALIVIDAS DC

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	5334	TX

General Provider Information

NPI Number	:	1417003237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANTINE S PALIVIDAS DC

Provider Business Mailing Address
First Line	:	909 DAIRY ASHFORD ST STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-5306
Country	:	US
Telephone Number	:	281-589-2424
Fax Number	:	281-589-2424

Provider Business Practice Location Address
First Line	:	909 DAIRY ASHFORD ST STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-5306
Country	:	US
Telephone Number	:	281-589-2424
Fax Number	:	281-589-2424

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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