Provider Demographics
NPI:1932277530
Name:JUAREZ-DREW, IRMA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:ANN
Last Name:JUAREZ-DREW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:IRMA
Other - Middle Name:ANN
Other - Last Name:JUAREZ-DREW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15679 BEAR VALLEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1791
Mailing Address - Country:US
Mailing Address - Phone:760-948-4888
Mailing Address - Fax:760-948-6400
Practice Address - Street 1:15679 BEAR VALLEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1791
Practice Address - Country:US
Practice Address - Phone:760-948-4888
Practice Address - Fax:760-948-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0220190OtherMEDICARE PTAN
U61707Medicare UPIN