Provider Demographics
NPI:1184784902
Name:GUADARA, JOANNE (DC)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:GUADARA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4812
Mailing Address - Country:US
Mailing Address - Phone:201-342-8266
Mailing Address - Fax:201-342-8788
Practice Address - Street 1:835 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4812
Practice Address - Country:US
Practice Address - Phone:201-342-8266
Practice Address - Fax:201-342-8788
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC3609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45745Medicare UPIN
NJGU541350Medicare ID - Type Unspecified