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General NPI Number Information
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NPI Number | 1770887036
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Entity Type | Individual
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Provider Name | RODRIGO JUAREZ JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 4614 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60609-4040
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Country | US
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Telephone | 773-823-7005
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Fax | 888-416-9095
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Provider Business Mailing Address
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Address Line | 4614 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60609-4040
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Country | US
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Telephone | 773-823-7005
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Fax | 888-416-9096
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038011846
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License Number State | IL
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