Provider Demographics
NPI:1851496665
Name:PICAZO, JOSE C (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:C
Last Name:PICAZO
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 1:1928 N CONWAY
Mailing Address - Street 2:STE 1
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-585-2225
Mailing Address - Fax:956-585-6883
Practice Address - Street 1:1928 N CONWAY
Practice Address - Street 2:STE 1
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-585-2225
Practice Address - Fax:956-585-6883
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611203Medicare ID - Type Unspecified