Provider Demographics
NPI:1578218129
Name:CARLOS, JONATHAN ANTHONY ENRIQUEZ (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN ANTHONY
Middle Name:ENRIQUEZ
Last Name:CARLOS
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 1:1403 LOMITA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2085
Mailing Address - Country:US
Mailing Address - Phone:818-573-8341
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2085
Practice Address - Country:US
Practice Address - Phone:818-573-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor