Provider Demographics
NPI:1003002122
Name:CULEBRA INJURY & PAIN CLINIC, LLC
Entity Type:Organization
Organization Name:CULEBRA INJURY & PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WAIKEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-733-9999
Mailing Address - Street 1:1430 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5909
Mailing Address - Country:US
Mailing Address - Phone:210-733-9999
Mailing Address - Fax:210-733-5233
Practice Address - Street 1:1430 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5909
Practice Address - Country:US
Practice Address - Phone:210-733-9999
Practice Address - Fax:210-733-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty