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General NPI Number Information
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NPI Number | 1750757506
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Entity Type | Organization
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Legal Business Name | UC4LIFE WELLNESS CENTER-METRO
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 2107 N SAINT MARYS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4140
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Country | US
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Telephone | 210-468-1891
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Fax | 210-568-4905
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Provider Business Mailing Address
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Address Line | 2107 N SAINT MARYS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4140
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JESSICA PAGE
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Credential |
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Telephone | 804-504-6114
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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 | X012282-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11313
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License Number State | TX
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