MEDICARE: CHAMPIONS CHIROPRACTIC CENTER, LLC

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	111NI0013X	Independent Medical Examiner Chiropractor	4295	TX

General Provider Information

NPI Number	:	1942613153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPIONS CHIROPRACTIC CENTER, LLC

Provider Business Mailing Address
First Line	:	3960 CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3521
Country	:	US
Telephone Number	:	281-440-6355
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3521
Country	:	US
Telephone Number	:	281-440-6355
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. R. KIRK ROYSE
Credential	:	DC
Telephone Number	:	281-440-6355

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	11/20/2015

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