Provider Demographics
NPI:1750523809
Name:GARCIA, BERTHA ALICIA
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:ALICIA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15635 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4025
Mailing Address - Country:US
Mailing Address - Phone:281-457-6210
Mailing Address - Fax:281-457-6213
Practice Address - Street 1:15635 AVENUE C
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4025
Practice Address - Country:US
Practice Address - Phone:281-457-6210
Practice Address - Fax:281-457-6213
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8582111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation