Healthcare Provider Details

I. General information

NPI: 1144382243
Provider Name (Legal Business Name): JAVIER V SUAREZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S BUENA VISTA ST
BURBANK CA
91505-4503
US

IV. Provider business mailing address

114 S BUENA VISTA ST
BURBANK CA
91505-4503
US

V. Phone/Fax

Practice location:
  • Phone: 818-563-2557
  • Fax: 818-563-1606
Mailing address:
  • Phone: 818-563-2557
  • Fax: 818-563-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number19621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: