Provider Demographics
NPI:1740575679
Name:MISSION CITY CHIROPRACTIC
Entity type:Organization
Organization Name:MISSION CITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAEGAN
Authorized Official - Middle Name:MOSELEY
Authorized Official - Last Name:STANGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-714-1161
Mailing Address - Street 1:28770 BERMUDA BAY WAY
Mailing Address - Street 2:#204
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1305
Mailing Address - Country:US
Mailing Address - Phone:972-345-0206
Mailing Address - Fax:
Practice Address - Street 1:17219 OCONNOR RD
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5678
Practice Address - Country:US
Practice Address - Phone:972-345-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty