MEDICARE: CLIFTON KAMTONG WAN 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	5125	TX

General Provider Information

NPI Number	:	1518070408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON KAMTONG WAN D.C.

Provider Business Mailing Address
First Line	:	PO BOX 884
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77497-0884
Country	:	US
Telephone Number	:	281-933-6677
Fax Number	:	281-933-6689

Provider Business Practice Location Address
First Line	:	11957 BISSONNET ST
Second Line	:	SUITE C-6
City	:	HOUSTON
State	:	TX
Zip	:	77099-1425
Country	:	US
Telephone Number	:	281-933-6677
Fax Number	:	281-933-6689

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/13/2013

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Directions to “ CLIFTON KAMTONG WAN D.C.” Practice Location

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