Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 14172 | TX |
N | 111NI0013X | Independent Medical Examiner | 14172 | TX |
Y | 111NR0400X | Rehabilitation Chiropractor | 14172 | TX |
NPI | 1083256663 |
---|---|
Provider Name | Dr. Jesus Daniel Castillo |
First Address | Mcallen, TX 78501-3961 |
Second Address | Mcallen, TX 78501-9335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2019 |
Last Update Date | 15/10/2019 |