Provider Demographics
NPI:1750415410
Name:CASTILLO, JUAN MANUEL (DC)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14114 VISTA MAR CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3452
Mailing Address - Country:US
Mailing Address - Phone:832-477-5113
Mailing Address - Fax:713-460-9702
Practice Address - Street 1:1400 W SAM HOUSTON PKWY N STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-3195
Practice Address - Country:US
Practice Address - Phone:713-460-9700
Practice Address - Fax:713-460-9702
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613350Medicare UPIN