Provider Demographics
NPI:1255589701
Name:TELLEZ, ELILIA MARLENE (DC)
Entity type:Individual
Prefix:
First Name:ELILIA
Middle Name:MARLENE
Last Name:TELLEZ
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 1:1842 SNAKE RIVER RD STE C
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7756
Mailing Address - Country:US
Mailing Address - Phone:713-586-1888
Mailing Address - Fax:
Practice Address - Street 1:1842 SNAKE RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7756
Practice Address - Country:US
Practice Address - Phone:713-586-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2997246Z00000X
TX10975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No111N00000XChiropractic ProvidersChiropractor