Provider Demographics
NPI:1477305928
Name:INNERBLOOM CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:INNERBLOOM CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILMALISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATAL RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-632-8484
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-0368
Mailing Address - Country:US
Mailing Address - Phone:787-632-8484
Mailing Address - Fax:
Practice Address - Street 1:220 WESTERN AUTO PLAZA
Practice Address - Street 2:STE 203
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-292-0905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty