Provider Demographics
NPI:1912209222
Name:GUTIERREZ, JUAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:GUTIERREZ
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 1:169 WYTHE AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3102
Mailing Address - Country:US
Mailing Address - Phone:718-384-4480
Mailing Address - Fax:718-384-4470
Practice Address - Street 1:169 WYTHE AVE APT 105
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-3102
Practice Address - Country:US
Practice Address - Phone:718-384-4480
Practice Address - Fax:718-384-4470
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor