MEDICARE: PURA VIDA CHIROPRACTIC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	10880	TX

General Provider Information

NPI Number	:	1093016958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURA VIDA CHIROPRACTIC, PLLC

Provider Business Mailing Address
First Line	:	2318 NW MILITARY HWY STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2524
Country	:	US
Telephone Number	:	210-685-1994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 NW MILITARY HWY STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-2524
Country	:	US
Telephone Number	:	210-685-1994
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL FOSS
Credential	:	DC
Telephone Number	:	210-685-1994

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	05/11/2020

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