Provider Demographics
NPI:1336320480
Name:BASTIDAS CORPORATION
Entity Type:Organization
Organization Name:BASTIDAS CORPORATION
Other - Org Name:BELTWAY HEALTHCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:FABIAN
Authorized Official - Last Name:BASTIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-981-8018
Mailing Address - Street 1:9894 BISSONNET ST.
Mailing Address - Street 2:SUITE 235
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8241
Mailing Address - Country:US
Mailing Address - Phone:713-981-8018
Mailing Address - Fax:713-981-8032
Practice Address - Street 1:9894 BISSONNET ST.
Practice Address - Street 2:SUITE 235
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8241
Practice Address - Country:US
Practice Address - Phone:713-981-8018
Practice Address - Fax:713-981-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty