Provider Demographics
NPI:1164529434
Name:A2C2 LLC
Entity Type:Organization
Organization Name:A2C2 LLC
Other - Org Name:SAN PEDRO N. CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWIS-OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-490-9169
Mailing Address - Street 1:1006 CENTRAL PKWY S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5021
Mailing Address - Country:US
Mailing Address - Phone:210-490-9169
Mailing Address - Fax:210-545-7740
Practice Address - Street 1:1006 CENTRAL PKWY S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5021
Practice Address - Country:US
Practice Address - Phone:210-490-9169
Practice Address - Fax:210-545-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4193261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601934Medicare ID - Type Unspecified
TXT14399Medicare UPIN