MEDICARE: ELITE PAIN MANAGEMENT AND REHAB

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	225100000X	Physical Therapist		TX
2	111N00000X	Chiropractor		TX

General Provider Information

NPI Number	:	1689809063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PAIN MANAGEMENT AND REHAB

Provider Business Mailing Address
First Line	:	6300 SAMUELL BLVD # 145
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7137
Country	:	US
Telephone Number	:	214-751-8960
Fax Number	:	214-751-8965

Provider Business Practice Location Address
First Line	:	6300 SAMUELL BLVD # 145
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7137
Country	:	US
Telephone Number	:	214-751-8960
Fax Number	:	214-751-8965

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSE MAGBAG
Credential	:	D.C.
Telephone Number	:	713-459-1894

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	05/28/2009

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Directions to “ELITE PAIN MANAGEMENT AND REHAB ” Practice Location

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