Provider Demographics
NPI:1740083518
Name:ELIZONDO, MANUEL (DC)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 CULLEN BLVD APT 1504
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5071
Mailing Address - Country:US
Mailing Address - Phone:210-324-8970
Mailing Address - Fax:
Practice Address - Street 1:201 ENTERPRISE AVE STE 600B
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3086
Practice Address - Country:US
Practice Address - Phone:713-352-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor