Provider Demographics
NPI:1629794466
Name:OTERO, LUIS ARNALDO (DC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ARNALDO
Last Name:OTERO
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 1:22 ROCK HURST CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-7477
Mailing Address - Country:US
Mailing Address - Phone:787-512-5176
Mailing Address - Fax:
Practice Address - Street 1:175 SHENSTONE LN
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6904
Practice Address - Country:US
Practice Address - Phone:919-750-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor