Provider Demographics
NPI:1699181586
Name:PECAN COUNTRY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PECAN COUNTRY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCARAMOZI
Authorized Official - Suffix:V
Authorized Official - Credentials:DC
Authorized Official - Phone:210-289-5206
Mailing Address - Street 1:1300 N KING ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-3820
Mailing Address - Country:US
Mailing Address - Phone:830-549-5232
Mailing Address - Fax:830-549-5241
Practice Address - Street 1:1300 N KING ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-3820
Practice Address - Country:US
Practice Address - Phone:830-549-5232
Practice Address - Fax:830-549-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty