Provider Demographics
NPI:1023698487
Name:ROLON PAGAN, JESUS ESTEBAN III (DC)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ESTEBAN
Last Name:ROLON PAGAN
Suffix:III
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 1:24 CALLE DEGETAU
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6441
Mailing Address - Country:US
Mailing Address - Phone:787-455-0707
Mailing Address - Fax:
Practice Address - Street 1:24 CALLE DEGETAU
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6441
Practice Address - Country:US
Practice Address - Phone:787-455-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty