Provider Demographics
NPI:1568959989
Name:CLINICA QUIROPRACTICA CORRECTIVA SANTA ISABEL
Entity Type:Organization
Organization Name:CLINICA QUIROPRACTICA CORRECTIVA SANTA ISABEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-247-5221
Mailing Address - Street 1:227 CALLE CALIZA
Mailing Address - Street 2:URB. ALTURAS DE COAMO
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-247-5221
Mailing Address - Fax:
Practice Address - Street 1:45 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3122
Practice Address - Country:US
Practice Address - Phone:787-238-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty