Provider Demographics
NPI:1821079872
Name:REDONDO, JOSEPH M SR (DC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:REDONDO
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 CALLE CONCORDIA
Mailing Address - Street 2:EDIT GAL PROFESIONAL STE 202
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
Practice Address - Street 2:EDIT GAL PROFESIONAL STE 202
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0035125Medicare PIN
PR35125Medicare ID - Type Unspecified
U52018Medicare UPIN