Provider Demographics
NPI:1508508011
Name:ELEVATED CHIROPRACTIC AND SPORTS THERAPY, LLC.
Entity Type:Organization
Organization Name:ELEVATED CHIROPRACTIC AND SPORTS THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAEZ-CURCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-237-2731
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0716
Mailing Address - Country:US
Mailing Address - Phone:210-237-2731
Mailing Address - Fax:
Practice Address - Street 1:CARR. 174 BLOQUE 20-27
Practice Address - Street 2:SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-957-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty