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General NPI Number Information
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NPI Number | 1104186634
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Entity Type | Organization
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Legal Business Name | EAGLE PASS SPINE AND REHAB,LLC
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 2435 N VETERANS BLVD SUITE A
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City | EAGLE PASS
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State | TX
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Zip | 78852-6483
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Country | US
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Telephone | 830-776-5996
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Fax | 830-776-5992
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Provider Business Mailing Address
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Address Line | 2435 N VETERANS BLVD SUITE A
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City | EAGLE PASS
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State | TX
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Zip | 78852-6483
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Country | US
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Telephone | 830-776-5996
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Fax | 830-776-5992
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. NAKIA SHAWNEE LONG
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Credential |
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Telephone | 830-776-5996
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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 | 4664
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License Number State | TX
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