Provider Demographics
NPI:1659466621
Name:CASTILLO, MARTIN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:CASTILLO
Suffix:JR
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 1:615 S ASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5358
Mailing Address - Country:US
Mailing Address - Phone:956-393-1130
Mailing Address - Fax:956-782-8430
Practice Address - Street 1:615 S ASTER ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5358
Practice Address - Country:US
Practice Address - Phone:956-782-8400
Practice Address - Fax:956-782-8430
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9148111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F20525OtherMEDICARE PTAN