MEDICARE: OMNI HEALTH CHIROPRACTIC PLLC

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	225700000X	Massage Therapist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1740053552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI HEALTH CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	17102 HIGHWAY 46 W STE 14
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-7120
Country	:	US
Telephone Number	:	830-214-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	17102 HIGHWAY 46 W STE 14
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-7120
Country	:	US
Telephone Number	:	830-214-2211
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	JORDAN MASSO
Credential	:
Telephone Number	:	956-605-3762

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/02/2023

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