MEDICARE: CASTRO CHIROPRACTIC CENTER, P.A.

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	111N00000X	Chiropractor	9923	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8D2704	OTHER	TX	MEDICARE ID- TYPE UNSPECIFIED

General Provider Information

NPI Number	:	1124466784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTRO CHIROPRACTIC CENTER, P.A.

Provider Business Mailing Address
First Line	:	9400 CARNEGIE AVE
Second Line	:	UNIT D
City	:	EL PASO
State	:	TX
Zip	:	79925-1422
Country	:	US
Telephone Number	:	915-500-5741
Fax Number	:	915-581-6409

Provider Business Practice Location Address
First Line	:	9400 CARNEGIE AVE
Second Line	:	UNIT D
City	:	EL PASO
State	:	TX
Zip	:	79925-1422
Country	:	US
Telephone Number	:	915-500-5741
Fax Number	:	915-581-6409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARCO A CASTRO
Credential	:	D.C.
Telephone Number	:	915-500-5741

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	03/16/2016

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Directions to “CASTRO CHIROPRACTIC CENTER, P.A. ” Practice Location

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