Provider Demographics
NPI:1104927201
Name:LIFE CARE CHIROPRACTIC & REHABILITATION CENTERS
Entity type:Organization
Organization Name:LIFE CARE CHIROPRACTIC & REHABILITATION CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:915-881-8000
Mailing Address - Street 1:6065 MONTANA AVE STE C9
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1839
Mailing Address - Country:US
Mailing Address - Phone:915-881-8000
Mailing Address - Fax:915-881-8108
Practice Address - Street 1:6065 MONTANA AVE STE C9
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1839
Practice Address - Country:US
Practice Address - Phone:915-881-8000
Practice Address - Fax:915-881-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty