Provider Demographics
NPI:1710100102
Name:VILLANUEVA, ELENA P (DC)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:P
Last Name:VILLANUEVA
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 1:3267 BEE CAVES RD STE 107-187
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6700
Mailing Address - Country:US
Mailing Address - Phone:512-718-0700
Mailing Address - Fax:928-756-3480
Practice Address - Street 1:3267 BEE CAVES RD STE 107-187
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6700
Practice Address - Country:US
Practice Address - Phone:512-718-0700
Practice Address - Fax:928-756-3480
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610158Medicare PIN