MEDICARE: SPINECARE OF EL PASO, 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1245630755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINECARE OF EL PASO, LLC

Provider Business Mailing Address
First Line	:	7878 GATEWAY BLVD E
Second Line	:	SUITE 201
City	:	EL PASO
State	:	TX
Zip	:	79915-1838
Country	:	US
Telephone Number	:	915-253-1509
Fax Number	:	915-207-2003

Provider Business Practice Location Address
First Line	:	7878 GATEWAY BLVD E
Second Line	:	SUITE 201
City	:	EL PASO
State	:	TX
Zip	:	79915-1838
Country	:	US
Telephone Number	:	915-253-1509
Fax Number	:	915-207-2003

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DANIEL CHAVEZ
Credential	:	D.C.
Telephone Number	:	915-253-1509

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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