Provider Demographics
NPI:1275917825
Name:DE GOTI, JOSE JR (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:DE GOTI
Suffix:JR
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 1:10261 SW 72ND ST
Mailing Address - Street 2:SUITE C105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3023
Mailing Address - Country:US
Mailing Address - Phone:786-241-8794
Mailing Address - Fax:786-241-6701
Practice Address - Street 1:10261 SW 72ND ST
Practice Address - Street 2:SUITE C105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3023
Practice Address - Country:US
Practice Address - Phone:786-241-8794
Practice Address - Fax:786-241-6701
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor