Provider Demographics
NPI:1295313542
Name:SUJO, JUSTIN ALEXIS (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ALEXIS
Last Name:SUJO
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 1:5645 SW 163RD PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5643
Mailing Address - Country:US
Mailing Address - Phone:305-926-7898
Mailing Address - Fax:
Practice Address - Street 1:13710 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4040
Practice Address - Country:US
Practice Address - Phone:305-385-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor