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General NPI Number Information
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NPI Number | 1427241306
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Entity Type | Organization
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Legal Business Name | CANAVAN CENTER CHIROPRACTIC HEALTH CLINIC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 8647 WURZBACH RD BLDG H
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1296
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Country | US
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Telephone | 210-641-6355
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Fax | 210-641-7009
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Provider Business Mailing Address
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Address Line | 8647 WURZBACH ROAD BLDG H
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City | SAN ANTONIO
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State | TX
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Zip | 78240
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Country | US
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Telephone | 210-641-6355
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Fax | 210-641-7009
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Authorized Official
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Title or Position | OWNER
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Name | CARMEN N CARLILE
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Credential | D.C.
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Telephone | 210-641-6355
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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 |
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License Number State |
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