MEDICARE: ENLIGHTEN CHIROPRACTIC & ACUPUNCTURE

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	11215	TX

General Provider Information

NPI Number	:	1932438231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIGHTEN CHIROPRACTIC & ACUPUNCTURE

Provider Business Mailing Address
First Line	:	15501 ADLONG DR
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-3315
Country	:	US
Telephone Number	:	817-458-1025
Fax Number	:	888-848-3798

Provider Business Practice Location Address
First Line	:	2238 MICHIGAN AVE
Second Line	:	STE D
City	:	ARLINGTON
State	:	TX
Zip	:	76013-5945
Country	:	US
Telephone Number	:	817-458-1025
Fax Number	:	888-848-3798

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. VANDARA MOUNARATH
Credential	:	D.C.
Telephone Number	:	817-458-1025

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	12/15/2009

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