MEDICARE: SOUTH HOUSTON CHIROPRACTIC 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		TX

General Provider Information

NPI Number	:	1750818795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH HOUSTON CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	907 EL DORADO BLVD. STE. B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062
Country	:	US
Telephone Number	:	832-916-7642
Fax Number	:	832-518-1599

Provider Business Practice Location Address
First Line	:	8101 AIRPORT BLVD. STE. A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061
Country	:	US
Telephone Number	:	832-916-7642
Fax Number	:	832-518-1599

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MICHAEL T. MARTIN
Credential	:	D.C.
Telephone Number	:	830-609-8707

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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