MEDICARE: HAROLD LEE BLACK 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	DC4320	TX

General Provider Information

NPI Number	:	1972538346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD LEE BLACK DC

Provider Business Mailing Address
First Line	:	1315 HIGHWAY 1187 STE 101
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6134
Country	:	US
Telephone Number	:	817-473-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 HIGHWAY 1187 STE 101
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6134
Country	:	US
Telephone Number	:	817-473-6151
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	12/21/2007

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Directions to “ HAROLD LEE BLACK DC” Practice Location

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