Provider Demographics
NPI:1851737605
Name:FITSPINE CLINIC LLC
Entity Type:Organization
Organization Name:FITSPINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:CALBETO VAILLANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-706-1763
Mailing Address - Street 1:47 CALISTEMON
Mailing Address - Street 2:ESTANCIAS DE TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-706-1763
Mailing Address - Fax:
Practice Address - Street 1:AVE ROOSEVELT 1445 RESOLUCION 33
Practice Address - Street 2:DORAL BANK PLAZA PRIMER NIVEL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-706-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty