Provider Demographics
NPI:1497954085
Name:ULTIMATE FUNCTION CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ULTIMATE FUNCTION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-850-0900
Mailing Address - Street 1:1700 N ZARAGOZA RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7963
Mailing Address - Country:US
Mailing Address - Phone:915-850-0900
Mailing Address - Fax:915-850-0903
Practice Address - Street 1:1700 N ZARAGOZA RD
Practice Address - Street 2:SUITE 117
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7963
Practice Address - Country:US
Practice Address - Phone:915-850-0900
Practice Address - Fax:915-850-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF007881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9263112OtherAETNA
TX0058QCOtherBCBSOF TEXAS
TX9263112OtherAETNA