Provider Demographics
NPI:1396916227
Name:EL PASO CHIROPRACTIC GROUP
Entity type:Organization
Organization Name:EL PASO CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:D
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-775-2400
Mailing Address - Street 1:1700 N ZARAGOZA RD
Mailing Address - Street 2:STE 116-117
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7963
Mailing Address - Country:US
Mailing Address - Phone:915-850-0900
Mailing Address - Fax:
Practice Address - Street 1:1700 N ZARAGOZA RD
Practice Address - Street 2:STE 116-117
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7963
Practice Address - Country:US
Practice Address - Phone:915-850-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INJURY MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C0040OtherBCBS
4270807OtherAETNA
TX8AM290OtherBCBS TEXAS
10736690OtherCAQH
TX8AM290OtherBCBS TEXAS
10736690OtherCAQH