Healthcare Provider Details

I. General information

NPI: 1902088594
Provider Name (Legal Business Name): AIRROSTI CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 BLANCO RD SUITE 400
SAN ANTONIO TX
78216-4363
US

IV. Provider business mailing address

7410 BLANCO RD SUITE 400
SAN ANTONIO TX
78216-4363
US

V. Phone/Fax

Practice location:
  • Phone: 800-404-6050
  • Fax:
Mailing address:
  • Phone: 800-404-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: KELLY E GREEN
Title or Position: CEO
Credential:
Phone: 800-404-6050