Healthcare Provider Details

I. General information

NPI: 1073817821
Provider Name (Legal Business Name): CASTILLO CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W SAM HOUSTON PKWY N STE 140
HOUSTON TX
77043-3195
US

IV. Provider business mailing address

1400 W SAM HOUSTON PKWY N STE 140
HOUSTON TX
77043-3195
US

V. Phone/Fax

Practice location:
  • Phone: 713-460-9700
  • Fax: 713-460-9702
Mailing address:
  • Phone: 713-460-9700
  • Fax: 713-460-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number10418
License Number StateTX

VIII. Authorized Official

Name: DR. JUAN MANUEL CASTILLO
Title or Position: CHIROPRACTOR / OWNER
Credential: D.C.
Phone: 713-460-9700