Provider Demographics
NPI:1952432577
Name:UPTAIN-VILLA, JOE (DC)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:UPTAIN-VILLA
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 1:1098 SUNRISE AVE
Mailing Address - Street 2:190
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4467
Mailing Address - Country:US
Mailing Address - Phone:916-786-0212
Mailing Address - Fax:
Practice Address - Street 1:1098 SUNRISE AVE
Practice Address - Street 2:190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4467
Practice Address - Country:US
Practice Address - Phone:916-786-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0218270Medicare PIN
CADC218270Medicare UPIN