Provider Demographics
NPI:1265900625
Name:SANTIAGO, ESTEBAN (DC)
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 EMBASSY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4738
Mailing Address - Country:US
Mailing Address - Phone:727-849-1309
Mailing Address - Fax:
Practice Address - Street 1:2840 N HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3319
Practice Address - Country:US
Practice Address - Phone:727-849-1309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor