Provider Demographics
NPI:1679050231
Name:FADIA, PANKTI Y (DC)
Entity Type:Individual
Prefix:
First Name:PANKTI
Middle Name:Y
Last Name:FADIA
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 1:9902 POTRANCO RD STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-9611
Mailing Address - Country:US
Mailing Address - Phone:210-760-0339
Mailing Address - Fax:
Practice Address - Street 1:9902 POTRANCO RD STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9611
Practice Address - Country:US
Practice Address - Phone:281-865-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor