Provider Demographics
NPI:1427193655
Name:IZQUIERDO, JUAN-CARLOS (DC)
Entity Type:Individual
Prefix:DR
First Name:JUAN-CARLOS
Middle Name:
Last Name:IZQUIERDO
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 1:825 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6014
Mailing Address - Country:US
Mailing Address - Phone:212-956-5920
Mailing Address - Fax:212-245-4060
Practice Address - Street 1:825 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6014
Practice Address - Country:US
Practice Address - Phone:212-956-5920
Practice Address - Fax:212-245-4060
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006925-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician