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General NPI Number Information
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NPI Number | 1518140821
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Entity Type | Organization
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Legal Business Name | H.Q. CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 4100 BONHAM AVE
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City | ODESSA
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State | TX
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Zip | 79762-6204
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Country | US
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Telephone | 432-363-8182
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Fax | 432-363-0952
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Provider Business Mailing Address
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Address Line | 4100 BONHAM AVE
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City | ODESSA
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State | TX
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Zip | 79762-6204
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Country | US
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Telephone | 432-363-8182
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Fax | 432-363-0952
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | BENJAMIN CASEY QUIROZ
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Credential | D.C.
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Telephone | 432-363-8182
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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 | TX10226DC
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License Number State | TX
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