Provider Demographics
NPI:1144611252
Name:SANTIAGO, VICTOR MANUEL III (DC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:SANTIAGO
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 CYPRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3408
Mailing Address - Country:US
Mailing Address - Phone:407-530-5819
Mailing Address - Fax:
Practice Address - Street 1:827 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-3408
Practice Address - Country:US
Practice Address - Phone:407-530-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor