MEDICARE: DR. MANUEL ELIZONDO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	16413	TX

General Provider Information

NPI Number	:	1740083518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL ELIZONDO D.C.

Provider Business Mailing Address
First Line	:	1555 CULLEN BLVD APT 1504
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-5071
Country	:	US
Telephone Number	:	210-324-8970
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 ENTERPRISE AVE STE 600B
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3086
Country	:	US
Telephone Number	:	713-352-1951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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