Provider Demographics
NPI:1336412162
Name:SANDESARA, POORVI (DC)
Entity Type:Individual
Prefix:DR
First Name:POORVI
Middle Name:
Last Name:SANDESARA
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 1:12941 NORTH FWY
Mailing Address - Street 2:#216
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12941 NORTH FWY
Practice Address - Street 2:#216
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1240
Practice Address - Country:US
Practice Address - Phone:281-919-1095
Practice Address - Fax:281-919-2479
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor