Provider Demographics
NPI:1598901787
Name:CANTU, JUAN RICARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RICARDO
Last Name:CANTU
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 1:3450 38TH AVE
Mailing Address - Street 2:STE. 4
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6412
Mailing Address - Country:US
Mailing Address - Phone:563-570-8680
Mailing Address - Fax:
Practice Address - Street 1:3450 38TH AVE
Practice Address - Street 2:STE. 2
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6412
Practice Address - Country:US
Practice Address - Phone:563-570-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor