MEDICARE: KINSEY WELLNESS CORPORATION

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	7019	TX

General Provider Information

NPI Number	:	1922204171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINSEY WELLNESS CORPORATION

Provider Business Mailing Address
First Line	:	2656 SOUTH LOOP W
Second Line	:	SUITE 270
City	:	HOUSTON
State	:	TX
Zip	:	77054-2664
Country	:	US
Telephone Number	:	713-664-8150
Fax Number	:	713-664-8147

Provider Business Practice Location Address
First Line	:	2656 SOUTH LOOP W
Second Line	:	SUITE 270
City	:	HOUSTON
State	:	TX
Zip	:	77054-2664
Country	:	US
Telephone Number	:	713-664-8150
Fax Number	:	713-664-8147

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	CLINTON N KINSEY
Credential	:	D.C.
Telephone Number	:	713-664-8150

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	12/10/2007

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Directions to “KINSEY WELLNESS CORPORATION ” Practice Location

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