Provider Demographics
NPI:1669664355
Name:EVANGELISTA, FE MARIE TERESE (DC)
Entity Type:Individual
Prefix:DR
First Name:FE MARIE
Middle Name:TERESE
Last Name:EVANGELISTA
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 1:1100 GULF FWY S
Mailing Address - Street 2:SUITE 122
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5153
Mailing Address - Country:US
Mailing Address - Phone:281-557-3339
Mailing Address - Fax:832-932-5223
Practice Address - Street 1:1100 GULF FWY S
Practice Address - Street 2:SUITE 122
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5153
Practice Address - Country:US
Practice Address - Phone:281-557-3339
Practice Address - Fax:832-932-5223
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10342111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist