1811019177 NPI number — E R CHIROPRACTIC PC

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 1811019177 NPI number — E R CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E R CHIROPRACTIC PC
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:
6
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:
1811019177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700867
Provider Second Line Business Mailing Address:
THOUSAND OAKS UNITED CHIROPRACTIC
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78270-0867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-490-3555
Provider Business Mailing Address Fax Number:
210-490-3577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2235 THOUSAND OAKS
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78232-3966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-490-3555
Provider Business Practice Location Address Fax Number:
210-490-3577
Provider Enumeration Date:
04/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HELMS
Authorized Official First Name:
HOLLIS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
210-490-3555

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4453 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC4453 , 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)

  • Identifier: 177994700 . This is a "U S TREASUREY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88220Y . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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