Healthcare Provider Details

I. General information

NPI: 1255589701
Provider Name (Legal Business Name): ELILIA MARLENE TELLEZ D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 SNAKE RIVER RD STE C
KATY TX
77449-7756
US

IV. Provider business mailing address

1842 SNAKE RIVER RD STE C
KATY TX
77449-7756
US

V. Phone/Fax

Practice location:
  • Phone: 713-586-1888
  • Fax:
Mailing address:
  • Phone: 713-586-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number2997
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: