Provider Demographics
NPI:1922526516
Name:CANDELARIA REYES, ELSIE MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:MICHELLE
Last Name:CANDELARIA REYES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 COND PUERTA DEL PARQUE
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3147
Mailing Address - Country:US
Mailing Address - Phone:787-562-1194
Mailing Address - Fax:
Practice Address - Street 1:255 AVE PONCE DE LEON STE LB126
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-765-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR633111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty