Provider Demographics
NPI:1679206452
Name:TREVINO, OMERY X (DC)
Entity Type:Individual
Prefix:DR
First Name:OMERY
Middle Name:X
Last Name:TREVINO
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 1:3505 FLINT ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5962
Mailing Address - Country:US
Mailing Address - Phone:940-329-1818
Mailing Address - Fax:
Practice Address - Street 1:3000 CORPORATE CT STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2297
Practice Address - Country:US
Practice Address - Phone:469-251-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor