MEDICARE: MAGDALENO BANDA JR. 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	111NR0400X	Rehabilitation Chiropractor	9051	TX

General Provider Information

NPI Number	:	1669685202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDALENO BANDA JR. D.C.

Provider Business Mailing Address
First Line	:	4413 KINGFISH DR
Second Line	:
City	:	SEABROOK
State	:	TX
Zip	:	77586-2568
Country	:	US
Telephone Number	:	713-859-3797
Fax Number	:	281-474-2914

Provider Business Practice Location Address
First Line	:	8225 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-4503
Country	:	US
Telephone Number	:	713-649-8808
Fax Number	:	713-649-8823

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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