Provider Demographics
NPI:1376954347
Name:MARIANO ROMAN QUIROPRACTICO, CSP
Entity Type:Organization
Organization Name:MARIANO ROMAN QUIROPRACTICO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-785-2198
Mailing Address - Street 1:EA-27 CALLE TILO
Mailing Address - Street 2:URB. LOS ALMENDROS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-785-2198
Mailing Address - Fax:787-785-2198
Practice Address - Street 1:EA27 CALLE TILO
Practice Address - Street 2:URB. LOS ALMENDROS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3415
Practice Address - Country:US
Practice Address - Phone:787-785-2198
Practice Address - Fax:787-785-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00309261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0035110OtherMEDICARE
PR72724OtherTRIPLE-S