Provider Demographics
NPI:1003390261
Name:NIEVES-LOPEZ, JOSE RAFAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAFAEL
Last Name:NIEVES-LOPEZ
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 1:166 CALLE CONFRATERNIDAD
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-6215
Mailing Address - Country:US
Mailing Address - Phone:787-464-0184
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA PR 402 KM 2.9 BARRIO QUEBRADA LARGA
Practice Address - Street 2:LOCAL #6
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-464-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor