Provider Demographics
NPI:1063674729
Name:SAN ANTONIO PAIN AND REHAB CENTER
Entity Type:Organization
Organization Name:SAN ANTONIO PAIN AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANH
Authorized Official - Middle Name:TIEN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-343-2705
Mailing Address - Street 1:PO BOX 241979
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-8979
Mailing Address - Country:US
Mailing Address - Phone:210-927-7788
Mailing Address - Fax:210-923-6636
Practice Address - Street 1:1007 POTEET JOURDANTON FWY
Practice Address - Street 2:120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1207
Practice Address - Country:US
Practice Address - Phone:210-927-7788
Practice Address - Fax:210-923-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0099PKOtherBCBS