Healthcare Provider Details

I. General information

NPI: 1417313818
Provider Name (Legal Business Name): JUAN ESCOBAR QUINTERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 COLFAX AVE
WINTER PARK FL
32789-1822
US

IV. Provider business mailing address

912 COLFAX AVE
WINTER PARK FL
32789-1822
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-3223
  • Fax: 407-960-3767
Mailing address:
  • Phone: 407-644-3223
  • Fax: 407-960-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: