Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 11694 | TX |
Y | 111NR0400X | Rehabilitation Chiropractor | 11694 | TX |
NPI | 1154612984 |
---|---|
Provider Name | Juan Daniel Bazan |
First Address | San Antonio, TX 78232-5052 |
Second Address | New Braunfels, TX 78130-6396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 20/09/2013 |