Provider Demographics
NPI:1952644528
Name:CASTILLO, JORGE ELIAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ELIAS
Last Name:CASTILLO
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 1:260 S PARKER ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3599
Mailing Address - Country:US
Mailing Address - Phone:660-888-3995
Mailing Address - Fax:
Practice Address - Street 1:141 COUNTY ROAD 334
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:MO
Practice Address - Zip Code:65274-9695
Practice Address - Country:US
Practice Address - Phone:660-888-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010102111N00000X
MO2013009367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor