Provider Demographics
NPI:1649206574
Name:GARCIA, EDWARD RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RAY
Last Name:GARCIA
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 1:4502 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2604
Mailing Address - Country:US
Mailing Address - Phone:361-994-0000
Mailing Address - Fax:361-994-0003
Practice Address - Street 1:4502 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2604
Practice Address - Country:US
Practice Address - Phone:361-994-0000
Practice Address - Fax:361-994-0003
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor