Provider Demographics
NPI:1780784322
Name:GRAU, TINA P (DC)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:P
Last Name:GRAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MED COURT
Mailing Address - Street 2:STE 207
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3484
Mailing Address - Country:US
Mailing Address - Phone:210-545-2001
Mailing Address - Fax:210-545-2168
Practice Address - Street 1:510 MED COURT
Practice Address - Street 2:STE 207
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3484
Practice Address - Country:US
Practice Address - Phone:210-545-2001
Practice Address - Fax:210-545-2168
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780784322OtherBC/BS
TX1780784322OtherBC/BS