MEDICARE: DR. ROBERTO OMAR CANTU DC

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	9787	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8P1440	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649276213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO OMAR CANTU DC

Provider Business Mailing Address
First Line	:	3027 MARINA BAY DR
Second Line	:	203
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2888
Country	:	US
Telephone Number	:	832-864-3769
Fax Number	:	858-509-3993

Provider Business Practice Location Address
First Line	:	3027 MARINA BAY DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2729
Country	:	US
Telephone Number	:	832-864-3769
Fax Number	:	858-509-3993

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/21/2022

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