Provider Demographics
NPI:1821213307
Name:DR. EMILIO PAEZ CHIROPRACTIC CENTER, PSC.
Entity Type:Organization
Organization Name:DR. EMILIO PAEZ CHIROPRACTIC CENTER, PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-416-1560
Mailing Address - Street 1:PO BOX 8189
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8189
Mailing Address - Country:US
Mailing Address - Phone:787-416-1560
Mailing Address - Fax:
Practice Address - Street 1:URB. COSTA AZUL
Practice Address - Street 2:2DO PISO SUITE 204 & 206
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-416-1560
Practice Address - Fax:787-416-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58333Medicare ID - Type Unspecified
PRU58833Medicare UPIN