Healthcare Provider Details

I. General information

NPI: 1801831193
Provider Name (Legal Business Name): C.I.R.C.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/21/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 VIRGINIA PL
PORT LAVACA TX
77979-2510
US

IV. Provider business mailing address

2 VIRGINIA PL
PORT LAVACA TX
77979-2510
US

V. Phone/Fax

Practice location:
  • Phone: 361-551-2273
  • Fax: 361-552-1782
Mailing address:
  • Phone: 361-551-2273
  • Fax: 361-552-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC7271
License Number StateTX

VIII. Authorized Official

Name: DR. MARCUS G. CAUGHRON
Title or Position: OWNER
Credential: D.C.
Phone: 361-551-2273