Provider Demographics
NPI:1730267261
Name:TREVINO, VICTOR MANUEL IX (DC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:TREVINO
Suffix:IX
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CORPUS CHRISTI ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-8474
Mailing Address - Country:US
Mailing Address - Phone:956-724-6771
Mailing Address - Fax:956-724-8680
Practice Address - Street 1:418 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8474
Practice Address - Country:US
Practice Address - Phone:956-724-6771
Practice Address - Fax:956-724-8680
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3065DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor