MEDICARE: ASHFORD CHIROPRACTIC CENTER

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	5259	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00D83N	OTHER	TX	MEDICARE GROUP #

General Provider Information

NPI Number	:	1851597256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHFORD CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	1710 S DAIRY ASHFORD ST
Second Line	:	STE 109
City	:	HOUSTON
State	:	TX
Zip	:	77077-3853
Country	:	US
Telephone Number	:	281-870-1233
Fax Number	:	281-870-1037

Provider Business Practice Location Address
First Line	:	1710 S DAIRY ASHFORD ST
Second Line	:	STE 109
City	:	HOUSTON
State	:	TX
Zip	:	77077-3853
Country	:	US
Telephone Number	:	281-870-1233
Fax Number	:	281-870-1037

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. LESHA D ROBERTS
Credential	:	D.C.
Telephone Number	:	281-870-1233

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	11/26/2007

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