Provider Demographics
NPI:1760788335
Name:ALL-STAR CHIROPRACTIC, PSC
Entity Type:Organization
Organization Name:ALL-STAR CHIROPRACTIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-779-3333
Mailing Address - Street 1:AVE. SANTA JUANITA P-60
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-779-3333
Mailing Address - Fax:787-779-3300
Practice Address - Street 1:P60 AVE SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4954
Practice Address - Country:US
Practice Address - Phone:787-779-3333
Practice Address - Fax:787-779-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0385111N00000X
PR0406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty