Provider Demographics
NPI:1013932227
Name:DELA CRUZ, JUAN (DC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:DELA CRUZ
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 1:109 EAST 36TH STREET
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3447
Mailing Address - Country:US
Mailing Address - Phone:212-510-7020
Mailing Address - Fax:212-510-7021
Practice Address - Street 1:109 EAST 36TH STREET
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3447
Practice Address - Country:US
Practice Address - Phone:212-510-7020
Practice Address - Fax:212-510-7021
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010935-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400079598Medicare PIN
NYA400073838Medicare PIN
NYX7M56EQ711Medicare PIN