Provider Demographics
NPI:1194441790
Name:CASIANO-ORTIZ, JUAN LUIS (DC)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:LUIS
Last Name:CASIANO-ORTIZ
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 1:1775 W MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2835
Mailing Address - Country:US
Mailing Address - Phone:423-587-5805
Mailing Address - Fax:423-587-3311
Practice Address - Street 1:1775 W MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2835
Practice Address - Country:US
Practice Address - Phone:423-587-5805
Practice Address - Fax:423-587-3311
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor