Provider Demographics
NPI:1568746113
Name:CENTRO QUIROPRACTICO FAMILIAR DE CAYEY
Entity Type:Organization
Organization Name:CENTRO QUIROPRACTICO FAMILIAR DE CAYEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-431-9577
Mailing Address - Street 1:CALLE NUNEZ ROMEU 105 ESTE
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:787-431-9577
Mailing Address - Fax:
Practice Address - Street 1:CALLE NUNEZ ROMEU 105 ESTE
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737
Practice Address - Country:US
Practice Address - Phone:787-431-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR481302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization