Provider Demographics
NPI:1356401525
Name:MAURICIO, JOSE J (DC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:MAURICIO
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 1:4747 S CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1245
Mailing Address - Country:US
Mailing Address - Phone:407-240-8430
Mailing Address - Fax:407-438-8905
Practice Address - Street 1:4747 S CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-1245
Practice Address - Country:US
Practice Address - Phone:407-240-8430
Practice Address - Fax:407-438-8905
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5169160OtherAETNA
FL173908OtherCHIRO ALLIANCE CORP
FL8369250OtherCIGNA
FL229026OtherAMERIGROUP
FL22012Medicare ID - Type Unspecified
FL229026OtherAMERIGROUP