Provider Demographics
NPI:1447798582
Name:CENTRO QUIROPRACTICO FAMILIAR HUMACAO PSC
Entity Type:Organization
Organization Name:CENTRO QUIROPRACTICO FAMILIAR HUMACAO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FABIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AREVALO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-285-4528
Mailing Address - Street 1:PO BOX 362454
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2454
Mailing Address - Country:US
Mailing Address - Phone:787-285-4528
Mailing Address - Fax:787-285-4528
Practice Address - Street 1:CALLE DUFRESNE A-1, URB. SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3931
Practice Address - Country:US
Practice Address - Phone:787-285-4528
Practice Address - Fax:787-285-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR446261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service