Provider Demographics
NPI:1750030250
Name:BAEZA-MORALES, EDGAR LEONEL (DC)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:LEONEL
Last Name:BAEZA-MORALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:EDGAR
Other - Middle Name:LEONEL
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 700688
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0688
Mailing Address - Country:US
Mailing Address - Phone:210-477-7654
Mailing Address - Fax:
Practice Address - Street 1:5650 WOOLDRIDGE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2406
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14856OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS