Provider Demographics
NPI:1982632956
Name:SIVERIO, MYRNA LIZ (DC)
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:LIZ
Last Name:SIVERIO
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:PO BOX 6798
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6798
Mailing Address - Country:US
Mailing Address - Phone:787-746-3730
Mailing Address - Fax:787-703-2860
Practice Address - Street 1:CONSOLIDATED MALL SUITE C 06
Practice Address - Street 2:GAUTIER BENITEZ AVE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-3730
Practice Address - Fax:787-703-2860
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UOTH000Medicare UPIN
PR0068779Medicare ID - Type Unspecified