Provider Demographics
NPI:1407321920
Name:VITALIDAD QUIROPRACTICA
Entity Type:Organization
Organization Name:VITALIDAD QUIROPRACTICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:NICASIO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-671-7088
Mailing Address - Street 1:303 CALLE VILLAMIL
Mailing Address - Street 2:APT 1602
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-294-5543
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA LISSETTE
Practice Address - Street 2:B 3 CALLE MARGINAL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-999-6570
Practice Address - Fax:787-999-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty