Organization
COLONIES NORTH CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY M FENTON JR. DC (OWNER)
(210) 699-8153
Entity
Organization
Contact information
Practice address
3740 COLONY DR, SUITE 150, SAN ANTONIO, TX 78230-2234
(210) 699-8153
(210) 699-8299
Mailing address
3740 COLONY DR, SUITE 150, SAN ANTONIO, TX 78230-2234
(210) 699-8153
(210) 699-8299
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8684
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0076MS
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/05/2007
Last updated
06/19/2008
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