MEDICARE: RC CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor

General Provider Information

NPI Number	:	1063032910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RC CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	6955 N MESA ST STE 112
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4424
Country	:	US
Telephone Number	:	915-217-0193
Fax Number	:	915-703-6020

Provider Business Practice Location Address
First Line	:	6955 N MESA ST STE 112
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4424
Country	:	US
Telephone Number	:	915-217-0193
Fax Number	:	915-703-6020

Authorized Official
Title or Position	:	OWNER
Name	:	RICARDO CAZARES
Credential	:	DC
Telephone Number	:	915-217-0193

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	04/21/2020

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