Provider Demographics
NPI:1679263321
Name:PAGAN, JUAN CARLOS (DC)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:PAGAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:CARLOS
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:19005 US HIGHWAY 441 STE 111
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6708
Mailing Address - Country:US
Mailing Address - Phone:352-505-1459
Mailing Address - Fax:
Practice Address - Street 1:19005 US HIGHWAY 441 STE 111
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6708
Practice Address - Country:US
Practice Address - Phone:352-505-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor