Healthcare Provider Details

I. General information

NPI: 1497668651
Provider Name (Legal Business Name): JAN A PEREZ TAVAREZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S TOWNSHIP RD
PATASKALA OH
43062-8952
US

IV. Provider business mailing address

30 S TOWNSHIP RD
PATASKALA OH
43062-8952
US

V. Phone/Fax

Practice location:
  • Phone: 787-661-2354
  • Fax:
Mailing address:
  • Phone: 740-927-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number05577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: