Provider Demographics
NPI:1851409015
Name:BIDOT, JUAN CARLOS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:BIDOT
Suffix:JR
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:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1171
Mailing Address - Country:US
Mailing Address - Phone:787-254-6325
Mailing Address - Fax:787-254-6325
Practice Address - Street 1:1 CARR 100 # KM
Practice Address - Street 2:BARRIO MIRADERO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3802
Practice Address - Country:US
Practice Address - Phone:787-254-6325
Practice Address - Fax:787-254-6325
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRV-11016Medicare UPIN