Provider Demographics
NPI:1326703992
Name:ADVANCED REHAB CHIROPRACTIC
Entity Type:Organization
Organization Name:ADVANCED REHAB CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:RUIZ COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-310-8748
Mailing Address - Street 1:PO BOX 10015
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL PLAZA MILIANGIE BO. MONTELLANO CARR 14
Practice Address - Street 2:LOCAL 5
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-310-8748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center