Provider Demographics
NPI:1073632717
Name:YESQUEN, FELIX MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:MARTIN
Last Name:YESQUEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:FELIX
Other - Middle Name:MARTIN
Other - Last Name:YESQUEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2315 TECHNOLOGY DR. STE. 107
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368
Mailing Address - Country:US
Mailing Address - Phone:636-561-7774
Mailing Address - Fax:636-625-8007
Practice Address - Street 1:2315 TECHNOLOGY DR. STE. 107
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-561-7774
Practice Address - Fax:636-625-8007
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor