Provider Demographics
NPI:1790559201
Name:QUINTANA, CARLA SAUCEDO (DC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SAUCEDO
Last Name:QUINTANA
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 1:704 KINDRED LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3111
Mailing Address - Country:US
Mailing Address - Phone:210-763-7420
Mailing Address - Fax:
Practice Address - Street 1:18600 LYNDON B JOHNSON FWY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5628
Practice Address - Country:US
Practice Address - Phone:214-751-8992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15816111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition