Provider Demographics
NPI:1467903476
Name:CORPUS CHRISTI CHIROPRACTIC ASSOCIATES INC.
Entity Type:Organization
Organization Name:CORPUS CHRISTI CHIROPRACTIC ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-992-1851
Mailing Address - Street 1:5826 ESPLANADE DR
Mailing Address - Street 2:302
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4208
Mailing Address - Country:US
Mailing Address - Phone:361-992-1851
Mailing Address - Fax:
Practice Address - Street 1:5826 ESPLANADE DR
Practice Address - Street 2:302
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4173
Practice Address - Country:US
Practice Address - Phone:361-992-1851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty