Provider Demographics
NPI:1790286953
Name:ADVANCED CHIROPRACTIC SERVICES CORP PSC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC SERVICES CORP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:RODRIGUEZ AROCHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-344-7976
Mailing Address - Street 1:PO BOX 5332
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5332
Mailing Address - Country:US
Mailing Address - Phone:787-896-8817
Mailing Address - Fax:787-986-7375
Practice Address - Street 1:CARR 111 KM 16.8 INT
Practice Address - Street 2:BO GUATEMALA, SUIT 3
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-680-5103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR531111N00000X
FLCH11217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0380414400Medicaid