Provider Demographics
NPI:1770629123
Name:GARCIA, JUAN L (DC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:L
Last Name:GARCIA
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 1:8426 CACTUS CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1826
Mailing Address - Country:US
Mailing Address - Phone:210-684-9173
Mailing Address - Fax:
Practice Address - Street 1:702 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-2500
Practice Address - Country:US
Practice Address - Phone:210-921-2225
Practice Address - Fax:210-921-9651
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor