Provider Demographics
NPI:1811358690
Name:ELISE MARIA LLC
Entity type:Organization
Organization Name:ELISE MARIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-962-0182
Mailing Address - Street 1:3701 S COOPER ST
Mailing Address - Street 2:UNIT 185
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3445
Mailing Address - Country:US
Mailing Address - Phone:817-962-0182
Mailing Address - Fax:817-962-0128
Practice Address - Street 1:3701 S COOPER ST
Practice Address - Street 2:UNIT 185
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3445
Practice Address - Country:US
Practice Address - Phone:817-962-0182
Practice Address - Fax:817-962-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty