Provider Demographics
NPI:1689935108
Name:CLINICA QUIROPRACTICA DE PONCE, INC
Entity Type:Organization
Organization Name:CLINICA QUIROPRACTICA DE PONCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:REDONDO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:787-844-1130
Mailing Address - Street 1:8118 CALLE CONCORDIA SUITE 202
Mailing Address - Street 2:EDIFICIO GALERIA PROFESIONAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1514
Mailing Address - Country:US
Mailing Address - Phone:787-844-1130
Mailing Address - Fax:787-259-3939
Practice Address - Street 1:8118 CALLE CONCORDIA SUITE 202
Practice Address - Street 2:EDIFICIO GALERIA PROFESIONAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1514
Practice Address - Country:US
Practice Address - Phone:787-844-1130
Practice Address - Fax:787-259-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty