Provider Demographics
NPI:1750523536
Name:JAUREGUITO, JOEL THEODORE (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:THEODORE
Last Name:JAUREGUITO
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 1:1352 TROY RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3995
Mailing Address - Country:US
Mailing Address - Phone:208-882-1100
Mailing Address - Fax:
Practice Address - Street 1:1352 TROY RD
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3995
Practice Address - Country:US
Practice Address - Phone:208-882-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22726111NS0005X
NVB553111NS0005X
IDCHIA-1263111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician