Provider Demographics
NPI:1508945049
Name:ESTRADA, FIDEL (DC)
Entity Type:Individual
Prefix:MR
First Name:FIDEL
Middle Name:
Last Name:ESTRADA
Suffix:
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:PO BOX 9432
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9432
Mailing Address - Country:US
Mailing Address - Phone:787-750-9130
Mailing Address - Fax:787-750-9130
Practice Address - Street 1:AVE SANCHEZ OSORIO 5X23
Practice Address - Street 2:VILLA FONTANA PARK
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-750-9130
Practice Address - Fax:787-750-9130
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor