Provider Demographics
NPI:1811421332
Name:GARCIA, MIRANDA (DC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CENTRAL PKWY N STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5053
Mailing Address - Country:US
Mailing Address - Phone:800-404-6050
Mailing Address - Fax:866-313-3397
Practice Address - Street 1:16901 DALLAS PKWY STE 208
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5235
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:866-313-3397
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13429OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS