Provider Demographics
NPI:1144645375
Name:SAN ANTONIO FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SAN ANTONIO FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-699-0158
Mailing Address - Street 1:9386 HUEBNER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1652
Mailing Address - Country:US
Mailing Address - Phone:210-699-0158
Mailing Address - Fax:210-699-0255
Practice Address - Street 1:9386 HUEBNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1652
Practice Address - Country:US
Practice Address - Phone:210-699-0158
Practice Address - Fax:210-699-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13898Medicare UPIN