Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 13723 | TX |
N | 111NP0017X | Pediatric Chiropractor | 13723 | TX |
NPI | 1417456377 |
---|---|
Provider Name | Martha Manzanarez |
First Address | Houston, TX 77016-1709 |
Second Address | Conroe, TX 77304-1862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2018 |
Last Update Date | 06/02/2018 |