Provider Demographics
NPI:1770887036
Name:JUAREZ, RODRIGO JR (DC)
Entity type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:JUAREZ
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 1:4614 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-4040
Mailing Address - Country:US
Mailing Address - Phone:773-823-7005
Mailing Address - Fax:888-416-9096
Practice Address - Street 1:4614 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-4040
Practice Address - Country:US
Practice Address - Phone:773-823-7005
Practice Address - Fax:888-416-9095
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor