MEDICARE: YADIRA SANTIAGO 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	13395	TX

General Provider Information

NPI Number	:	1780123455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YADIRA SANTIAGO D.C.

Provider Business Mailing Address
First Line	:	5720 BROADWAY ST STE 102
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-7945
Country	:	US
Telephone Number	:	346-410-5465
Fax Number	:	346-410-5465

Provider Business Practice Location Address
First Line	:	10739 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77034-1857
Country	:	US
Telephone Number	:	346-410-5465
Fax Number	:

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

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	11/02/2020

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Directions to “ YADIRA SANTIAGO D.C.” Practice Location

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