Provider Demographics
NPI:1497114524
Name:BACK TO THE GARDEN CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BACK TO THE GARDEN CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASA
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-819-3481
Mailing Address - Street 1:2053 AVE PEDRO ALBIZU CAMPOS
Mailing Address - Street 2:SUITE 2, PMB 133
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5950
Mailing Address - Country:US
Mailing Address - Phone:787-819-3481
Mailing Address - Fax:
Practice Address - Street 1:CARR. 107 KM 1.3
Practice Address - Street 2:EDIFICIO ROMAN 1
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-819-3481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty