MEDICARE: PRY CHIROPRACTIC

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	2708	TX

General Provider Information

NPI Number	:	1548510936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7642 PARK PLACE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4526
Country	:	US
Telephone Number	:	713-645-4191
Fax Number	:	713-640-2253

Provider Business Practice Location Address
First Line	:	7642 PARK PLACE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-4526
Country	:	US
Telephone Number	:	713-645-4191
Fax Number	:	713-640-2253

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GLEN PARKER
Credential	:	D.C.
Telephone Number	:	713-645-4191

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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Directions to “PRY CHIROPRACTIC ” Practice Location

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