Provider Demographics
NPI:1235880378
Name:LEBRON ACEVEDO, IVAN A (DC)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:A
Last Name:LEBRON ACEVEDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LEVITTOWN BOULEVARD
Mailing Address - Street 2:1800
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-639-8960
Mailing Address - Fax:
Practice Address - Street 1:LEVITTOWN BOULEVARD
Practice Address - Street 2:1800
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-639-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty