Provider Demographics
NPI:1962555391
Name:GUAJARDO, JOSE ROLANDO (DC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ROLANDO
Last Name:GUAJARDO
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 1:6901 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-2633
Mailing Address - Country:US
Mailing Address - Phone:713-928-6255
Mailing Address - Fax:713-928-6245
Practice Address - Street 1:6901 CANAL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-2633
Practice Address - Country:US
Practice Address - Phone:713-928-6255
Practice Address - Fax:713-928-6245
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8294111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation