MEDICARE: DR. PATRICK LEE HOUSER B.S, D.C

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	111NP0017X	Pediatric Chiropractor	4998	NC
2	111NX0800X	Orthopedic Chiropractor	4998	NC
3	111NN0400X	Neurology Chiropractor	4998	NC

General Provider Information

NPI Number	:	1912565755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK LEE HOUSER B.S, D.C

Provider Business Mailing Address
First Line	:	624 TYVOLA RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3585
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 TYVOLA RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3585
Country	:	US
Telephone Number	:	704-770-8436
Fax Number	:

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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