Provider Demographics
NPI:1770858706
Name:PRO-CARE SPINE CENTER, PLLC
Entity type:Organization
Organization Name:PRO-CARE SPINE CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOECKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-371-7478
Mailing Address - Street 1:1015 W 39TH 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4005
Mailing Address - Country:US
Mailing Address - Phone:512-371-7478
Mailing Address - Fax:
Practice Address - Street 1:2400 VETERANS BLVD
Practice Address - Street 2:# 25
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3181
Practice Address - Country:US
Practice Address - Phone:512-371-7478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty