MEDICARE: MIREYAH CONSTANCIO

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	16817	TX

General Provider Information

NPI Number	:	1629912613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIREYAH CONSTANCIO

Provider Business Mailing Address
First Line	:	2860 COUNTY ROAD 381
Second Line	:
City	:	EARLY
State	:	TX
Zip	:	76802-3271
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8905 BENBROOK BLVD
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-3484
Country	:	US
Telephone Number	:	682-471-3333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	04/18/2026

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Directions to “ MIREYAH CONSTANCIO ” Practice Location

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