Provider Demographics
NPI:1245388545
Name:VERON, JUAN PERRY C (PA-C, ATC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:PERRY C
Last Name:VERON
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 W HUTCHINSON ST
Mailing Address - Street 2:#207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4842 W HUTCHINSON ST
Practice Address - Street 2:#207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1621
Practice Address - Country:US
Practice Address - Phone:773-283-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960023212255A2300X
IL085003757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer