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General NPI Number Information
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NPI Number | 1003002122
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Entity Type | Organization
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Legal Business Name | CULEBRA INJURY & PAIN CLINIC, LLC
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1430 CULEBRA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78201-5909
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Country | US
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Telephone | 210-733-9999
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Fax | 210-733-5233
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Provider Business Mailing Address
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Address Line | 1430 CULEBRA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78201-5909
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Country | US
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Telephone | 210-733-9999
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Fax | 210-733-5233
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Authorized Official
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Title or Position | CHIROPRACTOR/PROPRIETOR
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Name | PATRICK WAIKEM
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Credential | D.C.
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Telephone | 210-733-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC8485
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License Number State | TX
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