Provider Demographics
NPI:1730416405
Name:BACA, ESAIAS ISACC (DC)
Entity type:Individual
Prefix:
First Name:ESAIAS
Middle Name:ISACC
Last Name:BACA
Suffix:
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 1:2211 NORFOLK ST
Mailing Address - Street 2:STE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4096
Mailing Address - Country:US
Mailing Address - Phone:713-522-9814
Mailing Address - Fax:712-522-3047
Practice Address - Street 1:2211 NORFOLK STREET
Practice Address - Street 2:105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098
Practice Address - Country:US
Practice Address - Phone:346-348-2222
Practice Address - Fax:712-522-3047
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB136985Medicare PIN
TXTXB106535Medicare PIN