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General NPI Number Information
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NPI Number | 1912364159
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Entity Type | Organization
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Legal Business Name | OHAW OF SAN ANTONIO, LLC
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 5819 NW LOOP 410 #152
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City | SAN ANTONIO
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State | TX
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Zip | 78238-2520
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Country | US
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Telephone | 210-681-3333
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Fax | 210-681-3333
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Provider Business Mailing Address
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Address Line | 5819 NW LOOP 410 #152
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City | SAN ANTONIO
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State | TX
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Zip | 78238-2520
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Country | US
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Telephone | 210-681-3333
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Fax | 210-681-3333
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN CLAY SUGGS
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Credential | D.O.
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Telephone | 210-681-3333
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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 | 04378
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License Number State | TX
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