Provider Demographics
NPI:1780347138
Name:FUENTES NEVAREZ, CHRISTIAN (DC)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:FUENTES NEVAREZ
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 1:9 BANCROFT ST APT 512
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3979
Mailing Address - Country:US
Mailing Address - Phone:939-286-0606
Mailing Address - Fax:
Practice Address - Street 1:236 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2195
Practice Address - Country:US
Practice Address - Phone:603-605-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4728111N00000X
NH1101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor