Provider Demographics
NPI:1760021463
Name:DUARTE, JOAO CARLOS TAVEIRA (DC)
Entity Type:Individual
Prefix:DR
First Name:JOAO CARLOS
Middle Name:TAVEIRA
Last Name:DUARTE
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 1:7 MACONDRAY ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-8311
Mailing Address - Country:US
Mailing Address - Phone:401-692-2470
Mailing Address - Fax:
Practice Address - Street 1:875 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-6024
Practice Address - Country:US
Practice Address - Phone:401-275-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor