Provider Demographics
NPI:1023032943
Name:SOBERANIS, JOSE ALEJANDRO (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:SOBERANIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:612 N STORY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6764
Mailing Address - Country:US
Mailing Address - Phone:972-514-6278
Mailing Address - Fax:469-713-2444
Practice Address - Street 1:612 N STORY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6764
Practice Address - Country:US
Practice Address - Phone:972-514-6278
Practice Address - Fax:469-713-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3621Medicare PIN