Provider Demographics
NPI:1831289065
Name:GRACIA, ESMERALDA (DC)
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:GRACIA
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 1:1213 E ALTON GLOOR BLVD
Mailing Address - Street 2:STE. I
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3905
Mailing Address - Country:US
Mailing Address - Phone:956-554-0533
Mailing Address - Fax:956-554-0588
Practice Address - Street 1:1213 E ALTON GLOOR BLVD
Practice Address - Street 2:STE. I
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3905
Practice Address - Country:US
Practice Address - Phone:956-554-0533
Practice Address - Fax:956-554-0588
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W445Medicare ID - Type UnspecifiedPROVIDER #