Healthcare Provider Details

I. General information

NPI: 1912242314
Provider Name (Legal Business Name): JUAN GARCIA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 SE MILITARY DR SUITE 107
SAN ANTONIO TX
78214-2800
US

IV. Provider business mailing address

1313 SE MILITARY DR SUITE 107
SAN ANTONIO TX
78214-2800
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-4884
  • Fax: 210-921-0398
Mailing address:
  • Phone: 210-924-4884
  • Fax: 210-921-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12089
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: