Healthcare Provider Details

I. General information

NPI: 1134746704
Provider Name (Legal Business Name): ALEXANDER HECTOR ESCAMILLA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 BELLAIRE BLVD
BELLAIRE TX
77401-3905
US

IV. Provider business mailing address

PO BOX 700688
SAN ANTONIO TX
78270-0688
US

V. Phone/Fax

Practice location:
  • Phone: 713-492-5239
  • Fax:
Mailing address:
  • Phone: 210-318-3007
  • Fax: 210-468-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number14442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: