Healthcare Provider Details

I. General information

NPI: 1770537979
Provider Name (Legal Business Name): JOSE ISAIAS MUNIZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 GRAND PASS
CANYON LAKE TX
78133-3376
US

IV. Provider business mailing address

1091 GRAND PASS
CANYON LAKE TX
78133-3376
US

V. Phone/Fax

Practice location:
  • Phone: 838-800-1105
  • Fax: 915-503-2087
Mailing address:
  • Phone: 830-800-1105
  • Fax: 915-503-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9422
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: