Healthcare Provider Details

I. General information

NPI: 1497844476
Provider Name (Legal Business Name): VICTOR PATRICK GUTIERREZ JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 PARK AVE
PLAINFIELD NJ
07060-1611
US

IV. Provider business mailing address

108 JOHN ST
SOUTH PLAINFIELD NJ
07080-2807
US

V. Phone/Fax

Practice location:
  • Phone: 908-834-1209
  • Fax:
Mailing address:
  • Phone: 908-769-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00633700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: