Provider Demographics
NPI:1306967229
Name:SANTANA, JOSE ANTONIO (DC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:SANTANA
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 1:22791 VISTAWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5502
Mailing Address - Country:US
Mailing Address - Phone:561-182-8306
Mailing Address - Fax:
Practice Address - Street 1:22791 VISTAWOOD WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5502
Practice Address - Country:US
Practice Address - Phone:561-182-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005163111N00000X
CO4036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70704OtherBLUE CROSS BLUE SHIELD
FL70704OtherBLUE CROSS BLUE SHIELD