Provider Demographics
NPI:1306439294
Name:ESTRADA, JESUS LEMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:LEMUEL
Last Name:ESTRADA
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 1:5868 FARINGDON PL # 4
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3931
Mailing Address - Country:US
Mailing Address - Phone:984-212-4382
Mailing Address - Fax:
Practice Address - Street 1:5868 FARINGDON PL # 4
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3931
Practice Address - Country:US
Practice Address - Phone:787-315-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor