Provider Demographics
NPI:1346445749
Name:ACCIDENT AND SPORTS INJURY CLINIC
Entity Type:Organization
Organization Name:ACCIDENT AND SPORTS INJURY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-680-5133
Mailing Address - Street 1:9179 GRISSOM RD
Mailing Address - Street 2:STE. # 131
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2809
Mailing Address - Country:US
Mailing Address - Phone:210-680-5133
Mailing Address - Fax:210-680-4772
Practice Address - Street 1:9179 GRISSOM RD
Practice Address - Street 2:STE. # 131
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2809
Practice Address - Country:US
Practice Address - Phone:210-680-5133
Practice Address - Fax:210-680-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty