Provider Demographics
NPI:1174166078
Name:ACOSTA, PETER BRYAN V (DC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:BRYAN V
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 HENDERSON PASS APT 907
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3258
Mailing Address - Country:US
Mailing Address - Phone:210-763-7390
Mailing Address - Fax:
Practice Address - Street 1:17323 IH 35 N STE 106
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1278
Practice Address - Country:US
Practice Address - Phone:210-646-6000
Practice Address - Fax:210-651-0665
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor