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General NPI Number Information
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NPI Number | 1548406770
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS CHIROPRACTIC & REHAB
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 1717 N LAURENT ST STE 100
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City | VICTORIA
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State | TX
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Zip | 77901-6243
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Country | US
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Telephone | 361-485-1225
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Fax | 361-485-1226
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Provider Business Mailing Address
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Address Line | PO BOX 7101
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City | VICTORIA
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State | TX
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Zip | 77903-7101
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Country | US
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Telephone | 361-485-1225
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Fax | 361-485-1226
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES STEWART CANTU
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Credential | D.C.
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Telephone | 361-485-1225
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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 | 9502
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License Number State | TX
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