Provider Demographics
NPI:1750030250
Name:BAEZA-MORALES, EDGAR LEONEL (DC)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:LEONEL
Last Name:BAEZA-MORALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:EDGAR
Other - Middle Name:LEONEL
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1777 N RECORD ST APT 2104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-1259
Mailing Address - Country:US
Mailing Address - Phone:903-316-4676
Mailing Address - Fax:
Practice Address - Street 1:3701 W NORTHWEST HWY STE 303
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4962
Practice Address - Country:US
Practice Address - Phone:214-352-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14856OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS