Provider Demographics
NPI:1780123455
Name:SANTIAGO, YADIRA (DC)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:SANTIAGO
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 1:5720 BROADWAY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7945
Mailing Address - Country:US
Mailing Address - Phone:346-410-5465
Mailing Address - Fax:346-410-5465
Practice Address - Street 1:10739 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-1857
Practice Address - Country:US
Practice Address - Phone:346-410-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor