Provider Demographics
NPI:1235305012
Name:CORONA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:CORONA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:HENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-440-0629
Mailing Address - Street 1:606 N ED CAREY DR
Mailing Address - Street 2:STE A
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7504
Mailing Address - Country:US
Mailing Address - Phone:956-440-0629
Mailing Address - Fax:956-444-0245
Practice Address - Street 1:606 N ED CAREY DR
Practice Address - Street 2:STE A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7504
Practice Address - Country:US
Practice Address - Phone:956-440-0629
Practice Address - Fax:956-444-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088501402Medicaid
TX088501402Medicaid
U63454Medicare UPIN