Provider Demographics
NPI:1396900304
Name:MAGANA, RAOUL MICHEAL (DC)
Entity type:Individual
Prefix:DR
First Name:RAOUL
Middle Name:MICHEAL
Last Name:MAGANA
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 1:2111 W KETTLEMAN LN STE C
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4336
Mailing Address - Country:US
Mailing Address - Phone:209-334-6180
Mailing Address - Fax:
Practice Address - Street 1:2111 W KETTLEMAN LN STE C
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4336
Practice Address - Country:US
Practice Address - Phone:209-334-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23550111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation