Provider Demographics
NPI:1164567483
Name:AC & SC, PC
Entity Type:Organization
Organization Name:AC & SC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:OTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-308-7473
Mailing Address - Street 1:13133 NW MILITARY HWY
Mailing Address - Street 2:STE# 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1813
Mailing Address - Country:US
Mailing Address - Phone:210-308-7473
Mailing Address - Fax:210-479-2709
Practice Address - Street 1:13133 NW MILITARY HWY
Practice Address - Street 2:STE# 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1813
Practice Address - Country:US
Practice Address - Phone:210-308-7473
Practice Address - Fax:210-479-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6583111N00000X
TX1170429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0023PCOtherBLUECROSS & BLUESHIELD
TX605170Medicare ID - Type Unspecified