Healthcare Provider Details

I. General information

NPI: 1952467813
Provider Name (Legal Business Name): THERESA ELIZABETH ESTRADA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SAN PEDRO AVE
SAN ANTONIO TX
78212-4611
US

IV. Provider business mailing address

701 SAN PEDRO AVE
SAN ANTONIO TX
78212-4611
US

V. Phone/Fax

Practice location:
  • Phone: 210-354-2020
  • Fax: 210-354-4871
Mailing address:
  • Phone: 210-354-2020
  • Fax: 210-354-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC5326
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: