MEDICARE: BUBBYCOR, LLC

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

General Provider Information

NPI Number	:	1699433854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUBBYCOR, LLC

Provider Business Mailing Address
First Line	:	7814 BLACK GAP DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-1959
Country	:	US
Telephone Number	:	832-665-5943
Fax Number	:

Provider Business Practice Location Address
First Line	:	16103 W LITTLE YORK RD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-6867
Country	:	US
Telephone Number	:	281-855-9858
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN R CRESWELL
Credential	:
Telephone Number	:	832-665-5943

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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