Provider Demographics
NPI:1073044194
Name:BIENESTAR QUIROPRACTICO DR MARQUEZ COLLAZO CSP
Entity Type:Organization
Organization Name:BIENESTAR QUIROPRACTICO DR MARQUEZ COLLAZO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-605-3188
Mailing Address - Street 1:6501 CAMINOS VERDES
Mailing Address - Street 2:CARR. 844 , ATP. 603
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:UM
Mailing Address - Phone:787-605-3188
Mailing Address - Fax:
Practice Address - Street 1:6501 CAMINOS VERDES CARR 844
Practice Address - Street 2:ATP 603
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7826
Practice Address - Country:US
Practice Address - Phone:787-605-3188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHR544AMedicare PIN