Provider Demographics
NPI:1629414545
Name:BACON, JOEL F (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:F
Last Name:BACON
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 1:1800 VETERANS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3577
Mailing Address - Country:US
Mailing Address - Phone:830-774-4355
Mailing Address - Fax:
Practice Address - Street 1:1800 VETERANS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3577
Practice Address - Country:US
Practice Address - Phone:830-774-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2717111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic