Basic Information
| Provider Information | |||||||||
| NPI: | 1366710576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRASCO | ||||||||
| FirstName: | ALFONSO | ||||||||
| MiddleName: | ISMAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3940 BRECKENRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799361206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156290263 | ||||||||
| FaxNumber: | 9155940863 | ||||||||
| Practice Location | |||||||||
| Address1: | 11212 MONTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799364241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155909355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2011 | ||||||||
| LastUpdateDate: | 12/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 10763 | TX | Y | Chiropractic Providers | Chiropractor |
No ID Information.