Provider Demographics
NPI:1144494972
Name:NIETO CHIROPRACTIC
Entity type:Organization
Organization Name:NIETO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-329-8764
Mailing Address - Street 1:12805 TIERRA LINCE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5305
Mailing Address - Country:US
Mailing Address - Phone:915-329-8764
Mailing Address - Fax:915-921-6911
Practice Address - Street 1:12805 TIERRA LINCE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-5305
Practice Address - Country:US
Practice Address - Phone:915-329-8764
Practice Address - Fax:915-921-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty