MEDICARE: DR. SOMPHONE AMPHONE D.C.

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	CH8888	FL

General Provider Information

NPI Number	:	1487699757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOMPHONE AMPHONE D.C.

Provider Business Mailing Address
First Line	:	6065 HILLCROFT ST
Second Line	:	SUITE 605
City	:	HOUSTON
State	:	TX
Zip	:	77081-1087
Country	:	US
Telephone Number	:	321-604-6678
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 HILLCROFT ST
Second Line	:	SUITE 605
City	:	HOUSTON
State	:	TX
Zip	:	77081-1087
Country	:	US
Telephone Number	:	321-604-6678
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	10/29/2012

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