Provider Demographics
NPI:1518623149
Name:GUERRA, JOSE JESUS JR (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JESUS
Last Name:GUERRA
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 1:9943 N HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2028
Mailing Address - Country:US
Mailing Address - Phone:469-531-5755
Mailing Address - Fax:
Practice Address - Street 1:9943 N HARRISON DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2028
Practice Address - Country:US
Practice Address - Phone:469-531-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021043667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor