Provider Demographics
NPI:1619423654
Name:MALDONADO ORTIZ, LUIS (DC)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MALDONADO ORTIZ
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 1:3617 SHIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2301
Mailing Address - Country:US
Mailing Address - Phone:469-562-4347
Mailing Address - Fax:972-807-2766
Practice Address - Street 1:5100 BELT LINE RD
Practice Address - Street 2:SUITE 316
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7559
Practice Address - Country:US
Practice Address - Phone:972-807-2749
Practice Address - Fax:972-807-2766
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor