Provider Demographics
NPI:1558995027
Name:CRUZ, JOSE J (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:CRUZ
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 1:10750 W MCDOWELL RD STE F600
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5971
Mailing Address - Country:US
Mailing Address - Phone:787-934-6759
Mailing Address - Fax:
Practice Address - Street 1:10750 W MCDOWELL RD STE F600
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5971
Practice Address - Country:US
Practice Address - Phone:602-566-7676
Practice Address - Fax:602-566-7677
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8899111NX0100X, 111NX0800X, 111N00000X, 111NI0900X, 111NP0017X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation