Provider Demographics
NPI:1346348620
Name:TREMBLAY, SANDRA CARRELL (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:CARRELL
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:CARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4501 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1660
Mailing Address - Country:US
Mailing Address - Phone:210-828-9211
Mailing Address - Fax:210-828-9212
Practice Address - Street 1:4501 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1660
Practice Address - Country:US
Practice Address - Phone:210-828-9211
Practice Address - Fax:210-828-9212
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601489Medicare ID - Type Unspecified