Provider Demographics
NPI:1902946098
Name:ISQUIRDO, TYRONE LEE (DC, QME)
Entity Type:Individual
Prefix:DR
First Name:TYRONE
Middle Name:LEE
Last Name:ISQUIRDO
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32145 ALVARADO NILES RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2930
Mailing Address - Country:US
Mailing Address - Phone:510-471-2112
Mailing Address - Fax:510-471-1089
Practice Address - Street 1:32145 ALVARADO NILES RD
Practice Address - Street 2:SUITE 105
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2930
Practice Address - Country:US
Practice Address - Phone:510-471-2112
Practice Address - Fax:510-471-1089
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17714111NR0400X, 111NS0005X, 111NX0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0177140Medicare ID - Type Unspecified
CADC0177140Medicare UPIN