Provider Demographics
NPI:1891710109
Name:TAVARES, PAUL JORGE (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JORGE
Last Name:TAVARES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1828 E FLORENCE BLVD
Mailing Address - Street 2:STE. 137
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4783
Mailing Address - Country:US
Mailing Address - Phone:520-876-4119
Mailing Address - Fax:520-876-0483
Practice Address - Street 1:1828 E FLORENCE BLVD
Practice Address - Street 2:STE. 137
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4783
Practice Address - Country:US
Practice Address - Phone:520-876-4119
Practice Address - Fax:520-876-0483
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor