Provider Demographics
NPI:1417476268
Name:SAN ANTONIO ELITE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SAN ANTONIO ELITE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-822-2953
Mailing Address - Street 1:2397 NW MILITARY HWY STE D
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-2543
Mailing Address - Country:US
Mailing Address - Phone:210-342-3507
Mailing Address - Fax:
Practice Address - Street 1:2397 NW MILITARY HWY STE D
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-2543
Practice Address - Country:US
Practice Address - Phone:210-342-3507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13219OtherTBCE
1699122309OtherMEDICARE