Provider Demographics
NPI:1972780989
Name:COMPLETE INJURY CARE, INC
Entity type:Organization
Organization Name:COMPLETE INJURY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ESQUIVEL
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:915-667-4939
Mailing Address - Street 1:PO BOX 221347
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-4347
Mailing Address - Country:US
Mailing Address - Phone:915-533-0900
Mailing Address - Fax:915-533-3031
Practice Address - Street 1:6600 MONTANA AVE
Practice Address - Street 2:SUITE J
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2156
Practice Address - Country:US
Practice Address - Phone:915-667-4939
Practice Address - Fax:915-775-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018QWOtherBCBS OF TEXAS