Provider Demographics
NPI:1467214858
Name:PACHECO SPINE AND SPORT PLLC
Entity Type:Organization
Organization Name:PACHECO SPINE AND SPORT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-629-5126
Mailing Address - Street 1:1067 GILMER ST STE C
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4378
Mailing Address - Country:US
Mailing Address - Phone:903-629-5126
Mailing Address - Fax:903-307-5321
Practice Address - Street 1:1067 GILMER ST STE C
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4378
Practice Address - Country:US
Practice Address - Phone:903-629-5126
Practice Address - Fax:903-307-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty