Provider Demographics
NPI:1487653887
Name:GUILTINAN, MICHAEL P (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:GUILTINAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SEFORD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6035
Mailing Address - Country:US
Mailing Address - Phone:210-829-8937
Mailing Address - Fax:
Practice Address - Street 1:332 W SUNSET RD
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1755
Practice Address - Country:US
Practice Address - Phone:210-828-2665
Practice Address - Fax:210-826-2661
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601943Medicare ID - Type Unspecified
TXT13593Medicare UPIN