Provider Demographics
NPI:1316306715
Name:MEDINA CHIROPRACTIC SPORTS AND SPINE, PLLC
Entity type:Organization
Organization Name:MEDINA CHIROPRACTIC SPORTS AND SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:ABDIEL
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-457-0941
Mailing Address - Street 1:20607 DELTA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1987
Mailing Address - Country:US
Mailing Address - Phone:956-457-0941
Mailing Address - Fax:
Practice Address - Street 1:4724 SWEETWATER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3149
Practice Address - Country:US
Practice Address - Phone:956-457-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty