Provider Demographics
NPI:1124466784
Name:CASTRO CHIROPRACTIC CENTER, P.A.
Entity type:Organization
Organization Name:CASTRO CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-500-5741
Mailing Address - Street 1:9400 CARNEGIE AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1422
Mailing Address - Country:US
Mailing Address - Phone:915-500-5741
Mailing Address - Fax:915-581-6409
Practice Address - Street 1:9400 CARNEGIE AVE
Practice Address - Street 2:UNIT D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1422
Practice Address - Country:US
Practice Address - Phone:915-500-5741
Practice Address - Fax:915-581-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2704OtherMEDICARE ID- TYPE UNSPECIFIED
TX8D2704OtherMEDICARE ID- TYPE UNSPECIFIED