Provider Demographics
NPI:1083343792
Name:SPINNATE INTEGRATIVE CHIROPRACTIC STUDIO
Entity Type:Organization
Organization Name:SPINNATE INTEGRATIVE CHIROPRACTIC STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-354-1062
Mailing Address - Street 1:COBIANS PLAZA
Mailing Address - Street 2:SUITE 310 PONCE DE LEON 1607
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-354-1062
Mailing Address - Fax:
Practice Address - Street 1:COBIANS PLAZA
Practice Address - Street 2:SUITE 310 PONCE DE LEON 1607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-354-1062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty