Provider Demographics
NPI:1245544329
Name:SEVILLA, MAGDALENA MARIA (DC)
Entity type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:MARIA
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:MAGDALENA
Other - Middle Name:MARIA
Other - Last Name:KENNEDY, PACEK, ROZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7119 SAVANNAH GLEN LANE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:832-344-7757
Mailing Address - Fax:281-232-4971
Practice Address - Street 1:15200 SOUTHWEST FWY STE 285
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3866
Practice Address - Country:US
Practice Address - Phone:832-344-7757
Practice Address - Fax:281-232-4971
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor