Provider Demographics
NPI:1306199062
Name:QUIROPRACTICA DEL ENCANTO, CSP
Entity Type:Organization
Organization Name:QUIROPRACTICA DEL ENCANTO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:VELEZ-CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:789-500-3000
Mailing Address - Street 1:1751 AVE PAZ GRANELA
Mailing Address - Street 2:URB SANTIAGO IGLESIAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3630
Mailing Address - Country:US
Mailing Address - Phone:787-200-9144
Mailing Address - Fax:789-200-9108
Practice Address - Street 1:1751 AVE PAZ GRANELA
Practice Address - Street 2:URB SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3630
Practice Address - Country:US
Practice Address - Phone:787-200-9144
Practice Address - Fax:789-200-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037606900Medicaid