Provider Demographics
NPI:1063205052
Name:VICTORY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:VICTORY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-864-3004
Mailing Address - Street 1:436 CHASTE TREE DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4993
Mailing Address - Country:US
Mailing Address - Phone:425-864-3004
Mailing Address - Fax:
Practice Address - Street 1:120 RIVERWALK DR STE 308
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5597
Practice Address - Country:US
Practice Address - Phone:425-864-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710773577Medicaid