Provider Demographics
NPI:1063128007
Name:REQUENA-FERRER, JUAN SEBASTIAN (DC)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:SEBASTIAN
Last Name:REQUENA-FERRER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 CANTON RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0018
Mailing Address - Country:US
Mailing Address - Phone:770-424-4804
Mailing Address - Fax:
Practice Address - Street 1:3417 CANTON RD BLDG 2
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-0018
Practice Address - Country:US
Practice Address - Phone:770-424-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor