Provider Demographics
NPI:1720205982
Name:CENTRO QUIROPRACTICO GUAYNABO
Entity Type:Organization
Organization Name:CENTRO QUIROPRACTICO GUAYNABO
Other - Org Name:GRUPO QUIROPRACTICO DE GUAYNABO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-999-6570
Mailing Address - Street 1:COND. HILLSVIEW PLAZA
Mailing Address - Street 2:CALLE 59 UN APT. 206
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-667-5766
Mailing Address - Fax:787-999-6571
Practice Address - Street 1:ST. RD 169 AND ARBOLOTE AVE. #1
Practice Address - Street 2:PLAZA REAL SHOPPING CENTER SUITE 307
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:787-999-6570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty