Provider Demographics
NPI:1013975200
Name:BACA, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BACA
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:2745 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4405
Mailing Address - Country:US
Mailing Address - Phone:480-413-0586
Mailing Address - Fax:480-730-0487
Practice Address - Street 1:2745 S ALMA SCHOOL RD
Practice Address - Street 2:STE 2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-4405
Practice Address - Country:US
Practice Address - Phone:480-413-0586
Practice Address - Fax:480-730-0487
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ5837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ137080Medicare PIN