Provider Demographics
NPI:1467793539
Name:PETITCLERC, AURELIE (DC)
Entity Type:Individual
Prefix:
First Name:AURELIE
Middle Name:
Last Name:PETITCLERC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 BUFFALO SPEEDWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-4215
Mailing Address - Country:US
Mailing Address - Phone:832-744-5892
Mailing Address - Fax:
Practice Address - Street 1:5180 BUFFALO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4215
Practice Address - Country:US
Practice Address - Phone:832-744-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor