MEDICARE: PEAKFORM CHIROPRACTIC & REHAB LLC

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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1093538993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAKFORM CHIROPRACTIC & REHAB LLC

Provider Business Mailing Address
First Line	:	575 COMMERCIAL ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4211
Country	:	US
Telephone Number	:	830-872-0014
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 COMMERCIAL ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4211
Country	:	US
Telephone Number	:	830-776-1289
Fax Number	:	830-215-4893

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW RAPHAEL SANDOVAL
Credential	:	DC
Telephone Number	:	830-294-8111

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	03/02/2026

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