Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6111 | TX |
NPI | 1003935594 |
---|---|
Provider Name | Dr. Ramon Rosales JR. |
First Address | San Antonio, TX 78245-1002 |
Second Address | San Antonio, TX 78245-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 01/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
088438902 | (05) | TX |
U40473 | (02) |