Provider Demographics
NPI:1952467813
Name:ESTRADA, THERESA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ELIZABETH
Last Name:ESTRADA
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 1:701 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4611
Mailing Address - Country:US
Mailing Address - Phone:210-354-2020
Mailing Address - Fax:210-354-4871
Practice Address - Street 1:701 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4611
Practice Address - Country:US
Practice Address - Phone:210-354-2020
Practice Address - Fax:210-354-4871
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000603668OtherBLUE CROSS BLUE SHIELD
TX0000603668OtherBLUE CROSS BLUE SHIELD
TX603668Medicare ID - Type Unspecified