Provider Demographics
NPI:1518629633
Name:MANRIQUEZ, MARIBEL (DC)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:MANRIQUEZ
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 1:5357 LAS COLINAS BLVD APT 2203
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4475
Mailing Address - Country:US
Mailing Address - Phone:915-256-9415
Mailing Address - Fax:
Practice Address - Street 1:580 DECKER DR STE 201
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3961
Practice Address - Country:US
Practice Address - Phone:972-998-4100
Practice Address - Fax:972-890-2385
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor