Provider Demographics
NPI:1821288291
Name:ESMERALDA GRACIA
Entity Type:Organization
Organization Name:ESMERALDA GRACIA
Other - Org Name:GRACIA CHIROPRACTIC & WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-554-0533
Mailing Address - Street 1:1213 E ALTON GLOOR BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3906
Mailing Address - Country:US
Mailing Address - Phone:956-554-0533
Mailing Address - Fax:956-554-0588
Practice Address - Street 1:1213 E ALTON GLOOR BLVD STE I
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3906
Practice Address - Country:US
Practice Address - Phone:956-554-0533
Practice Address - Fax:956-554-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9743261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W45OtherMEDICARE