Provider Demographics
NPI:1639506090
Name:CENTRO QUIROPRACTICO DE LA SALUD LLC
Entity Type:Organization
Organization Name:CENTRO QUIROPRACTICO DE LA SALUD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-750-1420
Mailing Address - Street 1:PO BOX 8776
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8776
Mailing Address - Country:US
Mailing Address - Phone:787-750-1420
Mailing Address - Fax:787-762-6119
Practice Address - Street 1:RL11 VIA 21
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3946
Practice Address - Country:US
Practice Address - Phone:787-750-1420
Practice Address - Fax:787-762-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty