Provider Demographics
NPI:1023178811
Name:SKI BOLD PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:SKI BOLD PROFESSIONAL ASSOCIATION
Other - Org Name:CHIROPLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-923-3341
Mailing Address - Street 1:417 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1619
Mailing Address - Country:US
Mailing Address - Phone:210-923-3341
Mailing Address - Fax:210-924-9115
Practice Address - Street 1:417 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1619
Practice Address - Country:US
Practice Address - Phone:210-923-3341
Practice Address - Fax:210-924-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4487111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty