Provider Demographics
NPI:1114785060
Name:ENDURO CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ENDURO CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:IVAN G. RODRIGUEZ
Authorized Official - Middle Name:TORRES -
Authorized Official - Last Name:RICCI N. GONZALEZ MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:787-298-4516
Mailing Address - Street 1:URB JARDINES DEL CARIBE
Mailing Address - Street 2:00-36 CALLE 49
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-298-4516
Mailing Address - Fax:
Practice Address - Street 1:1241 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0943
Practice Address - Country:US
Practice Address - Phone:787-298-4516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty