MEDICARE: DR. MICHAEL A ONTIVEROS D.C.

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	9815	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F5089	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8V5180	OTHER	TX	BC/BS OF TEXAS

General Provider Information

NPI Number	:	1174561351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A ONTIVEROS D.C.

Provider Business Mailing Address
First Line	:	3800 N MESA ST
Second Line	:	STE C-1
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:	915-838-1500
Fax Number	:	915-838-1700

Provider Business Practice Location Address
First Line	:	3800 N MESA ST
Second Line	:	STE C-1
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:	915-838-1500
Fax Number	:	915-838-1700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	10/01/2012

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Directions to “ DR. MICHAEL A ONTIVEROS D.C.” Practice Location

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