Provider Demographics
NPI:1740085711
Name:EAGLE CHIROPRACTIC AND REHAB LLC
Entity type:Organization
Organization Name:EAGLE CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:713-899-7350
Mailing Address - Street 1:415 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4508
Mailing Address - Country:US
Mailing Address - Phone:830-213-8123
Mailing Address - Fax:
Practice Address - Street 1:415 MADISON ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4508
Practice Address - Country:US
Practice Address - Phone:830-213-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor