Provider Demographics
NPI:1689641003
Name:JIMENEZ, LAURA E (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO LAS CUMBRES
Mailing Address - Street 2:349 AVE FELISA R DE GAUTIER STE.207
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6673
Mailing Address - Country:US
Mailing Address - Phone:787-625-0707
Mailing Address - Fax:787-625-0705
Practice Address - Street 1:PASEO LAS CUMBRES
Practice Address - Street 2:349 AVE FELISA R DE GAUTIER STE.207
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6673
Practice Address - Country:US
Practice Address - Phone:787-625-0707
Practice Address - Fax:787-625-0705
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR375PR111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100225OtherLA CRUZ AZUL DE PR
PR9590134OtherHUMANA INSURANCE
PR68040OtherTRIPLE S