Provider Demographics
NPI:1457083172
Name:NIEVES CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NIEVES CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-464-0184
Mailing Address - Street 1:166 CALLE CONFRATERNIDAD
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-6215
Mailing Address - Country:US
Mailing Address - Phone:787-464-0184
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA PR 402 KM 2.9 BARRIO QUEBRADA LARGA
Practice Address - Street 2:SUITE #6
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-464-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038811100Medicaid