Provider Demographics
NPI:1184856361
Name:MARQUEZ-VIDAL, SANDRA YVONNE (DC/LAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:YVONNE
Last Name:MARQUEZ-VIDAL
Suffix:
Gender:F
Credentials:DC/LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 E. WHITTIER BLVD
Mailing Address - Street 2:#77
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:562-708-1393
Mailing Address - Fax:
Practice Address - Street 1:7754 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602
Practice Address - Country:US
Practice Address - Phone:562-708-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26098111N00000X
CAAC9754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist