Provider Demographics
NPI:1629140389
Name:JUAREZ, JOE LOUIS JR (DC)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:LOUIS
Last Name:JUAREZ
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15679 BEAR VALLEY RD
Mailing Address - Street 2:STE B
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1761
Mailing Address - Country:US
Mailing Address - Phone:760-948-4888
Mailing Address - Fax:760-948-6400
Practice Address - Street 1:15679 BEAR VALLEY RD
Practice Address - Street 2:STE B
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1761
Practice Address - Country:US
Practice Address - Phone:760-948-4888
Practice Address - Fax:760-948-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93679Medicare UPIN