Healthcare Provider Details

I. General information

NPI: 1073964938
Provider Name (Legal Business Name): RGV CHIROPRACTIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 W JEFFERSON AVE
HARLINGEN TX
78550-5247
US

IV. Provider business mailing address

18812 THIEME RD
HARLINGEN TX
78552-1733
US

V. Phone/Fax

Practice location:
  • Phone: 956-622-3430
  • Fax:
Mailing address:
  • Phone: 956-622-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10433
License Number StateTX

VIII. Authorized Official

Name: MARTHA J GARCIA
Title or Position: OFFICE MANAGER
Credential:
Phone: 956-622-3430