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General NPI Number Information
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NPI Number | 1194852483
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Entity Type | Organization
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Legal Business Name | ONE SOURCE FAMILY CHIROPRACTIC PA
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 132 JACKSON LN
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City | SAN MARCOS
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State | TX
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Zip | 78666-7222
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Country | US
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Telephone | 512-392-5750
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Fax | 512-392-5320
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Provider Business Mailing Address
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Address Line | 132 JACKSON LN
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City | SAN MARCOS
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State | TX
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Zip | 78666-7222
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Country | US
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Telephone | 512-392-5750
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Fax | 512-392-5320
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | MRS. SARAH JANE MORENO
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Credential | DC
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Telephone | 512-392-5750
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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 | F006540
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License Number State | TX
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