MEDICARE: DR. JASON L. BASILE DC

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	7968	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	609133	OTHER	TX	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	605887	OTHER	TX	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1881879278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON L. BASILE DC

Provider Business Mailing Address
First Line	:	5701 WOODWAY DR
Second Line	:	SUITE 225
City	:	HOUSTON
State	:	TX
Zip	:	77057-1515
Country	:	US
Telephone Number	:	713-532-2555
Fax Number	:	713-532-2999

Provider Business Practice Location Address
First Line	:	5701 WOODWAY DR
Second Line	:	SUITE 225
City	:	HOUSTON
State	:	TX
Zip	:	77057-1515
Country	:	US
Telephone Number	:	713-532-2555
Fax Number	:	713-532-2999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	04/18/2008

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