Provider Demographics
NPI:1174680607
Name:CHIROPRACTIC OF SAN ANGELO, PC
Entity Type:Organization
Organization Name:CHIROPRACTIC OF SAN ANGELO, PC
Other - Org Name:STOTTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:STOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-949-8688
Mailing Address - Street 1:3184 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6802
Mailing Address - Country:US
Mailing Address - Phone:325-949-8688
Mailing Address - Fax:325-944-2235
Practice Address - Street 1:3184 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6802
Practice Address - Country:US
Practice Address - Phone:325-949-8688
Practice Address - Fax:325-944-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5195111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT95928Medicare UPIN