Provider Demographics
NPI:1467706804
Name:THE Q WELLNESS CENTER/DOCTOR QUIROPRACTICO INC.
Entity Type:Organization
Organization Name:THE Q WELLNESS CENTER/DOCTOR QUIROPRACTICO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR QUIROPRACTICO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:BIDOT AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-254-6325
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1171
Mailing Address - Country:US
Mailing Address - Phone:787-254-6325
Mailing Address - Fax:787-254-6325
Practice Address - Street 1:CARR 100 KM 5.1 SOLAR 3
Practice Address - Street 2:BARRIO MIRADERO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-254-6325
Practice Address - Fax:787-254-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRV-11016Medicare UPIN