Provider Demographics
NPI:1417065491
Name:DE LA VARA, JUAN IGNACIO (DC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:IGNACIO
Last Name:DE LA VARA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1880 S PIERCE ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-7191
Mailing Address - Country:US
Mailing Address - Phone:303-763-8433
Mailing Address - Fax:303-936-0705
Practice Address - Street 1:1880 S PIERCE ST
Practice Address - Street 2:SUITE 14
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-7191
Practice Address - Country:US
Practice Address - Phone:303-763-8433
Practice Address - Fax:303-936-0705
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO4650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor