Provider Demographics
NPI:1508624891
Name:MOLINA, ELYSSA GABRIELLE (DC)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:GABRIELLE
Last Name:MOLINA
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 1:200 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-5050
Mailing Address - Country:US
Mailing Address - Phone:832-556-3297
Mailing Address - Fax:
Practice Address - Street 1:6503 GARTH RD STE 120
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-5631
Practice Address - Country:US
Practice Address - Phone:281-784-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor