MEDICARE: HA RICK PHAN DC

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	8912	TX

General Provider Information

NPI Number	:	1609034990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HA RICK PHAN DC

Provider Business Mailing Address
First Line	:	5322 HIDALGO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-6209
Country	:	US
Telephone Number	:	713-203-1467
Fax Number	:

Provider Business Practice Location Address
First Line	:	5322 HIDALGO ST
Second Line	:	SUITE 301
City	:	HOUSTON
State	:	TX
Zip	:	77056-6209
Country	:	US
Telephone Number	:	713-203-1467
Fax Number	:	713-944-4878

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	11/16/2011

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Directions to “ HA RICK PHAN DC” Practice Location

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