Provider Demographics
NPI:1144577081
Name:CASTILLO, MAXIMILIANO III (DC)
Entity Type:Individual
Prefix:DR
First Name:MAXIMILIANO
Middle Name:
Last Name:CASTILLO
Suffix:III
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 1:1020 N DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-462-0600
Mailing Address - Fax:817-462-0601
Practice Address - Street 1:1020 N DAVIS DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3240
Practice Address - Country:US
Practice Address - Phone:817-462-0600
Practice Address - Fax:817-462-0601
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor