Provider Demographics
NPI:1780112821
Name:MENDOZA, EDGAR V
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:V
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 WESTMONT DR STE 547
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4365
Mailing Address - Country:US
Mailing Address - Phone:713-455-7074
Mailing Address - Fax:
Practice Address - Street 1:1140 WESTMONT DR STE 547
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4365
Practice Address - Country:US
Practice Address - Phone:713-455-7074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12339OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS