Provider Demographics
NPI:1740956275
Name:HIDALGO, ANTIOCO JR (DC)
Entity type:Individual
Prefix:
First Name:ANTIOCO
Middle Name:
Last Name:HIDALGO
Suffix:JR
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 1:260 SAN JUAN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3024
Mailing Address - Country:US
Mailing Address - Phone:831-524-4406
Mailing Address - Fax:
Practice Address - Street 1:16130 JUAN HERNANDEZ DR STE 104
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5527
Practice Address - Country:US
Practice Address - Phone:408-778-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor