MEDICARE: PABLO ESPANA DC DABCO

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	DC4185	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B0081205	OTHER	TX	BCBS UPIN
2	DC4185	OTHER	TX	CHIROPRACTOR
3	8AD500	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1881724664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO ESPANA DC DABCO

Provider Business Mailing Address
First Line	:	PO BOX 5226
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-9226
Country	:	US
Telephone Number	:	214-942-4015
Fax Number	:	214-942-4980

Provider Business Practice Location Address
First Line	:	1107 W JEFFERSON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-5145
Country	:	US
Telephone Number	:	214-942-4015
Fax Number	:	214-942-4980

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	04/22/2010

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Directions to “ PABLO ESPANA DC DABCO” Practice Location

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