Provider Demographics
NPI:1114461613
Name:QUIROPRACTIVE LLC
Entity Type:Organization
Organization Name:QUIROPRACTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-424-8541
Mailing Address - Street 1:B10 CALLE MAGNOLIA
Mailing Address - Street 2:URB EL DORADO
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-3718
Mailing Address - Fax:
Practice Address - Street 1:1194 CALLE NICOLAS AGUAYO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:939-337-0239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00547Medicaid