MEDICARE: AIRLINE CHIROPRACTIC AND REHABILITATION, P.A.

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	5661	TX

General Provider Information

NPI Number	:	1790973493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRLINE CHIROPRACTIC AND REHABILITATION, P.A.

Provider Business Mailing Address
First Line	:	2215 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-2421
Country	:	US
Telephone Number	:	713-862-3230
Fax Number	:	713-862-2756

Provider Business Practice Location Address
First Line	:	2215 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-2421
Country	:	US
Telephone Number	:	713-633-1626
Fax Number	:	713-635-6253

Authorized Official
Title or Position	:	CHIROPRACTOR/PROPRIETOR
Name	:	JACK T. BARNETT
Credential	:	D.C.
Telephone Number	:	713-862-3230

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/10/2007

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