Provider Demographics
NPI:1972808533
Name:MAIRENA, NOEL E (DC)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:E
Last Name:MAIRENA
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 1:5316 WHITING WAY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6414
Mailing Address - Country:US
Mailing Address - Phone:903-306-9640
Mailing Address - Fax:972-238-1924
Practice Address - Street 1:901 N JUPITER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3244
Practice Address - Country:US
Practice Address - Phone:469-330-2225
Practice Address - Fax:972-238-1924
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor