Provider Demographics
NPI:1730434911
Name:STRATTON SPORT & SPINE
Entity type:Organization
Organization Name:STRATTON SPORT & SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-837-8244
Mailing Address - Street 1:PO BOX 593043
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0202
Mailing Address - Country:US
Mailing Address - Phone:210-837-8244
Mailing Address - Fax:210-569-6542
Practice Address - Street 1:300 E SONTERRA BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3971
Practice Address - Country:US
Practice Address - Phone:210-837-8244
Practice Address - Fax:210-569-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty