Healthcare Provider Details

I. General information

NPI: 1225667678
Provider Name (Legal Business Name): JUSTIN HOVARTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 CARVER RD
MODESTO CA
95350-4732
US

IV. Provider business mailing address

1012 CARVER RD
MODESTO CA
95350-4732
US

V. Phone/Fax

Practice location:
  • Phone: 209-549-2215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: