=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437259413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA JEANICE FLORES DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 02/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4040 SW MILITARY DRIVE
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78211-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-923-3861
-----------------------------------------------------
Fax | 210-923-8336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3534 MISTIC GRV
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78247-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-264-7919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 10262
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------