MEDICARE: HOUSTON SPINAL PAIN & REHAB 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	111NR0400X	Rehabilitation Chiropractor	8461	TX

General Provider Information

NPI Number	:	1477826584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON SPINAL PAIN & REHAB CLINIC

Provider Business Mailing Address
First Line	:	414B N SAM HOUSTON PKWY E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3508
Country	:	US
Telephone Number	:	281-260-7774
Fax Number	:	281-260-7779

Provider Business Practice Location Address
First Line	:	414B N SAM HOUSTON PKWY E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3508
Country	:	US
Telephone Number	:	281-260-7774
Fax Number	:	281-260-7779

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THO DUC LE
Credential	:	D.C
Telephone Number	:	281-260-7774

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	02/21/2012

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