Organization Active NPI

Pro-Care Spine Center, PLLC

  • General Practice Physician
  • San Antonio, TX
National Provider Identifier
1699214536
Registry record updated Feb 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PRO-CARE SPINE CENTER, PLLC
Practice address
7403 W Loop 1604 N
Suite 103
San Antonio, TX 78254-1888
Phone
(210) 881-0630
Fax
(210) 641-1608
NPI assigned
Feb 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Garland Brent Boecking
Title
Ceo
Phone
(512) 371-7478

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X TX
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X TX Primary

Addresses

Primary practice location

7403 W Loop 1604 N
Suite 103
San Antonio, TX 78254-1888

Mailing address

1015 W 39TH 1/2 St
Austin, TX 78756-4005
Phone (512) 371-7478

Other names 1

  • Pro-Care Medical Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1699214536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 W 39TH 1/2 ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787564005",
            "telephone_number": "512-371-7478",
            "fax_number": "512-371-3861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7403 W LOOP 1604 N",
            "address_2": "SUITE 103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782541888",
            "telephone_number": "210-881-0630",
            "fax_number": "210-641-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-CARE SPINE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "BOECKING",
        "authorized_official_first_name": "GARLAND",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-371-7478"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro-Care Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.