Provider Demographics
NPI:1326245820
Name:DEL NORTE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:DEL NORTE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DC
Authorized Official - Phone:915-593-2225
Mailing Address - Street 1:11601 PELLICANO DR STE A9
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6054
Mailing Address - Country:US
Mailing Address - Phone:915-593-2225
Mailing Address - Fax:915-593-2226
Practice Address - Street 1:11601 PELLICANO DR STE A9
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6054
Practice Address - Country:US
Practice Address - Phone:915-593-2225
Practice Address - Fax:915-593-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C7212Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER