Provider Demographics
NPI:1346664844
Name:GMIT TEXAS LLC
Entity Type:Organization
Organization Name:GMIT TEXAS LLC
Other - Org Name:UC4LIFE WELLNESS CENTER- STONE OAK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:LISERIO
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-897-9911
Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:STE. 140
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3943
Mailing Address - Country:US
Mailing Address - Phone:210-529-7090
Mailing Address - Fax:210-579-6729
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:STE. 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3943
Practice Address - Country:US
Practice Address - Phone:210-529-7090
Practice Address - Fax:210-579-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11313111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1689905390OtherINDIVIDUAL NPI