Provider Demographics
NPI:1720588999
Name:DR. GIOVONNI QUIROZ CHIROPRACTOR, INC.
Entity Type:Organization
Organization Name:DR. GIOVONNI QUIROZ CHIROPRACTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIOVONNI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-937-8796
Mailing Address - Street 1:4201 BROWN TRL STE 103
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3941
Mailing Address - Country:US
Mailing Address - Phone:817-268-9999
Mailing Address - Fax:
Practice Address - Street 1:4201 BROWN TRL STE 103
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3941
Practice Address - Country:US
Practice Address - Phone:817-268-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty