Provider Demographics
NPI:1942450465
Name:QUIROPRACTICOS DEL SUROESTE YAUCO C.S.P.
Entity Type:Organization
Organization Name:QUIROPRACTICOS DEL SUROESTE YAUCO C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:BOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-267-2444
Mailing Address - Street 1:64 CALLE MATTEI LLUBERAS
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3632
Mailing Address - Country:US
Mailing Address - Phone:787-267-2444
Mailing Address - Fax:787-267-2444
Practice Address - Street 1:64 CALLE MATTEI LLUBERAS
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3632
Practice Address - Country:US
Practice Address - Phone:787-267-2444
Practice Address - Fax:787-267-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty