MEDICARE: DR. EDGAR LEONEL BAEZA-MORALES DC

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	14856	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14856	OTHER	TX	TEXAS BOARD OF CHIROPRACTIC EXAMINERS

General Provider Information

NPI Number	:	1750030250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR LEONEL BAEZA-MORALES DC

Provider Business Mailing Address
First Line	:	1777 N RECORD ST APT 2104
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-1259
Country	:	US
Telephone Number	:	903-316-4676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 W NORTHWEST HWY STE 303
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4962
Country	:	US
Telephone Number	:	214-352-7246
Fax Number	:

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

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2025

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Directions to “ DR. EDGAR LEONEL BAEZA-MORALES DC” Practice Location

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