MEDICARE: DR. BRIAN JOSEPH SANSALONE 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	10646	TX

General Provider Information

NPI Number	:	1609079573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JOSEPH SANSALONE D.C.

Provider Business Mailing Address
First Line	:	1200 E MAIN ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4157
Country	:	US
Telephone Number	:	281-332-3428
Fax Number	:	281-332-7593

Provider Business Practice Location Address
First Line	:	1200 E MAIN ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4157
Country	:	US
Telephone Number	:	281-332-3428
Fax Number	:	281-332-7593

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. BRIAN JOSEPH SANSALONE D.C.” Practice Location

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