Provider Demographics
NPI:1548406770
Name:SOUTH TEXAS CHIROPRACTIC & REHAB
Entity Type:Organization
Organization Name:SOUTH TEXAS CHIROPRACTIC & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-485-1225
Mailing Address - Street 1:PO BOX 7101
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-7101
Mailing Address - Country:US
Mailing Address - Phone:361-485-1225
Mailing Address - Fax:361-485-1226
Practice Address - Street 1:1717 N LAURENT ST STE 100
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6243
Practice Address - Country:US
Practice Address - Phone:361-485-1225
Practice Address - Fax:361-485-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty