Provider Demographics
NPI:1154818623
Name:SOUTH TEXAS SPORTS AND PERFORMANCE
Entity Type:Organization
Organization Name:SOUTH TEXAS SPORTS AND PERFORMANCE
Other - Org Name:ARMADILLO SPORT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAUCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-654-4747
Mailing Address - Street 1:PO BOX 260537
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78426-0537
Mailing Address - Country:US
Mailing Address - Phone:361-654-4747
Mailing Address - Fax:361-654-4750
Practice Address - Street 1:3921 W RIVER DRIVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410
Practice Address - Country:US
Practice Address - Phone:361-654-4747
Practice Address - Fax:361-654-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty