Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5555 | TX |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 5555 | TX |
NPI | 1720116213 |
---|---|
Provider Name | Arnoldo Daniel Gutierrez |
First Address | San Antonio, TX 78216-4360 |
Second Address | San Antonio, TX 78216-4360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 03/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5555DC | WORKERS COMPENSATION (01) | TX |
605834 | BCBS (01) | TX |
742750876 | TAX ID (01) | TX |
U17417 | (02) | TX |