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General NPI Number Information
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NPI Number | 1053777292
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Entity Type | Organization
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Legal Business Name | SOUTHERN CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 3513 W ALBERTA RD
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City | EDINBURG
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State | TX
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Zip | 78539-8466
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Country | US
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Telephone | 956-627-0385
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Fax | 956-627-0399
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Provider Business Mailing Address
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Address Line | 3513 W ALBERTA RD
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City | EDINBURG
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State | TX
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Zip | 78539-8466
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Country | US
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Telephone | 956-627-0385
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Fax | 956-627-0399
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Authorized Official
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Title or Position | CLINIC DOCTOR
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Name | DR. BRADLEY GESSNER
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Credential | D.C.
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Telephone | 956-627-0385
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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 | 10446
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License Number State | TX
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