Provider Demographics
NPI:1497154025
Name:CENTRO QUIROPRACTICO DE GUAYNABO
Entity Type:Organization
Organization Name:CENTRO QUIROPRACTICO DE GUAYNABO
Other - Org Name:GRUPO QUIROPRACTICO DE GUAYNABO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-999-6570
Mailing Address - Street 1:#1 ALBOLOTE ST
Mailing Address - Street 2:PLAZA REAL SHOPPING CENTER STE 210
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-999-6570
Mailing Address - Fax:787-999-4586
Practice Address - Street 1:#1 ALBOLOTE ST
Practice Address - Street 2:PLAZA REAL SHOPPING CENTER STE 210
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-999-6570
Practice Address - Fax:787-999-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty