Provider Demographics
NPI:1669723862
Name:BARAJAS, JOSE MOISES (DC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MOISES
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:MOISES
Other - Last Name:BARAJAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6 S FOREST RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4802
Mailing Address - Country:US
Mailing Address - Phone:209-536-9182
Mailing Address - Fax:209-536-9124
Practice Address - Street 1:6 S FOREST RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4802
Practice Address - Country:US
Practice Address - Phone:209-536-9182
Practice Address - Fax:209-536-9124
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD.C. 32311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor