MEDICARE: SOUTHSIDE SPINAL CARE CLINIC LLC

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

General Provider Information

NPI Number	:	1467720755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE SPINAL CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	1730 SW MILITARY DR STE 104C
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1400
Country	:	US
Telephone Number	:	210-932-3731
Fax Number	:	210-932-3755

Provider Business Practice Location Address
First Line	:	1730 SW MILITARY DR STE 104C
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1400
Country	:	US
Telephone Number	:	210-932-3731
Fax Number	:	210-932-3755

Authorized Official
Title or Position	:	OWNER
Name	:	TOM RZSAS
Credential	:	D.C.
Telephone Number	:	210-932-3731

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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