Provider Demographics
NPI:1346330735
Name:CENTRO QUIROPRACTICO DR JUAN M LOPEZ DC-PSC
Entity Type:Organization
Organization Name:CENTRO QUIROPRACTICO DR JUAN M LOPEZ DC-PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-734-2841
Mailing Address - Street 1:PO BOX 366602
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6602
Mailing Address - Country:US
Mailing Address - Phone:787-734-2841
Mailing Address - Fax:787-713-0027
Practice Address - Street 1:CARR. PR 31 KM 24.0
Practice Address - Street 2:JUNCOS PLAZA LOCAL A-02
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-2841
Practice Address - Fax:787-713-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005-7856Medicare UPIN