Provider Demographics
NPI:1780731547
Name:GUAJARDO, SANTIAGO (DC)
Entity type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:
Last Name:GUAJARDO
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 1:3303 FM 1960 RD W STE 360
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3620
Mailing Address - Country:US
Mailing Address - Phone:281-880-9111
Mailing Address - Fax:281-880-9133
Practice Address - Street 1:3303 FM 1960 RD W STE 360
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3620
Practice Address - Country:US
Practice Address - Phone:281-880-9111
Practice Address - Fax:281-880-9133
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8882BOMedicare ID - Type Unspecified