Provider Demographics
NPI:1003221003
Name:CENTRO QUIROPRACTICO JOSE BOBONIS PSC
Entity Type:Organization
Organization Name:CENTRO QUIROPRACTICO JOSE BOBONIS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBONIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-269-2447
Mailing Address - Street 1:21-26 CARR 174
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6512
Mailing Address - Country:US
Mailing Address - Phone:787-269-2447
Mailing Address - Fax:787-269-2484
Practice Address - Street 1:21-26 CARR 174
Practice Address - Street 2:STA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6512
Practice Address - Country:US
Practice Address - Phone:787-269-2447
Practice Address - Fax:787-269-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR373261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU94242Medicare UPIN
PR0062772Medicare PIN