Provider Demographics
NPI:1720701584
Name:LOPEZ, CANDELARIO (DC)
Entity Type:Individual
Prefix:
First Name:CANDELARIO
Middle Name:
Last Name:LOPEZ
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 1:14210 HIGHWAY 3 STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1603
Mailing Address - Country:US
Mailing Address - Phone:832-240-4319
Mailing Address - Fax:
Practice Address - Street 1:14210 HIGHWAY 3
Practice Address - Street 2:STE 3
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1605
Practice Address - Country:US
Practice Address - Phone:832-240-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor