Provider Demographics
NPI:1932683679
Name:IBIS FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:IBIS FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IBIS
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:ROMAN GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-375-4820
Mailing Address - Street 1:28 CALLE SAN GERONIMO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5320
Mailing Address - Country:US
Mailing Address - Phone:787-375-4820
Mailing Address - Fax:
Practice Address - Street 1:URB ARECIBO GARDENS
Practice Address - Street 2:54 CALLE TENIENTE GARCIA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0061
Practice Address - Country:US
Practice Address - Phone:787-375-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty