Provider Demographics
NPI:1295493526
Name:PENADO, BLADIMIR ANTONIO (DC)
Entity type:Individual
Prefix:
First Name:BLADIMIR
Middle Name:ANTONIO
Last Name:PENADO
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 1:7426 TONSLEY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2131
Mailing Address - Country:US
Mailing Address - Phone:516-574-1779
Mailing Address - Fax:
Practice Address - Street 1:3111 FRY RD STE 170
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6742
Practice Address - Country:US
Practice Address - Phone:281-829-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty