Provider Demographics
NPI:1043530108
Name:CLINICA QUIROPRACTICA DR JACOB ANAYA
Entity Type:Organization
Organization Name:CLINICA QUIROPRACTICA DR JACOB ANAYA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-780-3762
Mailing Address - Street 1:CALLE SANTA CRUZ # 53
Mailing Address - Street 2:URB SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-0000
Mailing Address - Country:US
Mailing Address - Phone:787-780-3762
Mailing Address - Fax:787-787-0347
Practice Address - Street 1:CALLE SANTA CRUZ # 53
Practice Address - Street 2:URB SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0000
Practice Address - Country:US
Practice Address - Phone:787-780-3762
Practice Address - Fax:787-787-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU91423Medicare UPIN
PR60618Medicare PIN