Provider Demographics
NPI:1477891356
Name:ESTRADA, JOSE URIEL (D C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:URIEL
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 N KANSAS AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2372
Mailing Address - Country:US
Mailing Address - Phone:620-624-7773
Mailing Address - Fax:620-626-7396
Practice Address - Street 1:2330 N KANSAS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2372
Practice Address - Country:US
Practice Address - Phone:620-624-7773
Practice Address - Fax:620-626-7396
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor