Provider Demographics
NPI:1427241306
Name:CANAVAN CENTER CHIROPRACTIC HEALTH CLINIC
Entity type:Organization
Organization Name:CANAVAN CENTER CHIROPRACTIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARLILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-641-6355
Mailing Address - Street 1:8647 WURZBACH ROAD
Mailing Address - Street 2:BLDG H
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-641-6355
Mailing Address - Fax:210-641-7009
Practice Address - Street 1:8647 WURZBACH RD
Practice Address - Street 2:BLDG H
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1296
Practice Address - Country:US
Practice Address - Phone:210-641-6355
Practice Address - Fax:210-641-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608581OtherBLUE CROSS/BLUE SHIELD
TX8H0000OtherBLUE CROSS/BLUE SHIELD
TX8H0001OtherBLUE CROSS/BLUE SHIELD
TX601928Medicare PIN
TX8H0000OtherBLUE CROSS/BLUE SHIELD
TXU14182OtherUPIN
TX8H0000OtherBCBS