Basic Information
| Provider Information | |||||||||
| NPI: | 1154612984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAZAN | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 CENTRAL PKWY N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004046050 | ||||||||
| FaxNumber: | 8663133397 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 CREEKSIDE WAY | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781306396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325354466 | ||||||||
| FaxNumber: | 8663133397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 11694 | TX | N | Chiropractic Providers | Chiropractor | 111NR0400X | 11694 | TX | Y | Chiropractic Providers | Chiropractor | Rehabilitation |
No ID Information.