Provider Demographics
NPI:1346463916
Name:SAN GABRIEL CHIROPRACTIC PA
Entity Type:Organization
Organization Name:SAN GABRIEL CHIROPRACTIC PA
Other - Org Name:LONE STAR CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:ROB
Authorized Official - Last Name:KINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-869-0432
Mailing Address - Street 1:3010 WILLIAMS DR
Mailing Address - Street 2:STE. 21
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2764
Mailing Address - Country:US
Mailing Address - Phone:512-869-0432
Mailing Address - Fax:512-869-0375
Practice Address - Street 1:3010 WILLIAMS DR
Practice Address - Street 2:STE. 21
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2764
Practice Address - Country:US
Practice Address - Phone:512-869-0432
Practice Address - Fax:512-869-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty