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General NPI Number Information
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NPI Number | 1063735603
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Entity Type | Organization
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Legal Business Name | DR. GENENE PRADO
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 7600 HIGHWAY 29 W STE 7
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City | GEORGETOWN
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State | TX
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Zip | 78628-6938
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Country | US
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Telephone | 512-868-5123
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Fax | 512-560-6657
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Provider Business Mailing Address
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Address Line | PO BOX 1076
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City | LIBERTY HILL
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State | TX
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Zip | 78642-1076
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Country | US
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Telephone | 512-868-5123
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Fax | 512-560-6657
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Authorized Official
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Title or Position | OWNER
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Name | DR. GENENE PRADO
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Credential | DC
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Telephone | 512-868-5123
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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 | 6945
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License Number State | TX
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