1801130950 NPI number — HARLINGEN ACCIDENT & WELLNESS CENTER PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801130950 NPI number — HARLINGEN ACCIDENT & WELLNESS CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARLINGEN ACCIDENT & WELLNESS CENTER PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801130950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2302 S 77 SUNSHINESTRIP
Provider Second Line Business Mailing Address:
STE 101A
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-8313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-230-2202
Provider Business Mailing Address Fax Number:
956-230-2203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2302 S 77 SUNSHINESTRIP
Provider Second Line Business Practice Location Address:
STE 101A
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-230-2202
Provider Business Practice Location Address Fax Number:
956-230-2203
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SCHTUPAK
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
956-230-2202

Provider Taxonomy Codes

  • Taxonomy code: 111NX0100X , with the licence number:  10433 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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