Provider Demographics
NPI:1962606830
Name:CHIROPRACTIC NEUROLOGY INSTITUTE TX
Entity type:Organization
Organization Name:CHIROPRACTIC NEUROLOGY INSTITUTE TX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BUENTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-630-1616
Mailing Address - Street 1:PO BOX 3271
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3271
Mailing Address - Country:US
Mailing Address - Phone:956-630-1616
Mailing Address - Fax:
Practice Address - Street 1:801 E NOLANA ST
Practice Address - Street 2:SUITE #17
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6104
Practice Address - Country:US
Practice Address - Phone:956-630-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7934, 8743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962606830OtherNPI
TX00W463Medicare PIN