Provider Demographics
NPI:1225188048
Name:ANAYA, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:ANAYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
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
Practice Address - Country:US
Practice Address - Phone:787-780-3762
Practice Address - Fax:787-787-0347
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU91423Medicare UPIN
PR60618Medicare ID - Type Unspecified