Provider Demographics
NPI:1891327110
Name:SANTANA PEREZ, GISELLE MYRELIS (DC)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:MYRELIS
Last Name:SANTANA PEREZ
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 1:1515 RIO GRANDE DR APT 1111
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6742
Mailing Address - Country:US
Mailing Address - Phone:404-360-7560
Mailing Address - Fax:
Practice Address - Street 1:1220 N TOWN EAST BLVD STE 250
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4682
Practice Address - Country:US
Practice Address - Phone:972-279-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010295111N00000X
TX14900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor