Provider Demographics
NPI:1871631630
Name:SEPULVEDA, YESENIA JUANITA (DC CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:YESENIA
Middle Name:JUANITA
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 DUMAS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034
Mailing Address - Country:US
Mailing Address - Phone:832-338-8728
Mailing Address - Fax:713-947-3209
Practice Address - Street 1:2900 BROADWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017
Practice Address - Country:US
Practice Address - Phone:713-643-7011
Practice Address - Fax:713-643-3831
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
00549HMedicare ID - Type Unspecified
U93882Medicare UPIN