Provider Demographics
NPI:1003935594
Name:ROSALES, RAMON JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:ROSALES
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 DUGAS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1002
Mailing Address - Country:US
Mailing Address - Phone:210-674-2700
Mailing Address - Fax:210-674-4591
Practice Address - Street 1:9411 DUGAS DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1002
Practice Address - Country:US
Practice Address - Phone:210-674-2700
Practice Address - Fax:210-674-4591
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088438902Medicaid
TX088438902Medicaid
U40473Medicare UPIN