Provider Demographics
NPI:1992789010
Name:TORRES, JOHN R (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:TORRES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75958-0159
Mailing Address - Country:US
Mailing Address - Phone:936-560-1113
Mailing Address - Fax:936-560-3024
Practice Address - Street 1:181 COUNTY ROAD 238
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-7305
Practice Address - Country:US
Practice Address - Phone:936-560-1113
Practice Address - Fax:936-560-3024
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6230OtherBCBS
TX609298Medicare ID - Type Unspecified
U48603Medicare UPIN