Provider Demographics
NPI:1013507037
Name:CONCEPCION BETANCES, INDHIRA G
Entity Type:Individual
Prefix:
First Name:INDHIRA
Middle Name:G
Last Name:CONCEPCION BETANCES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 CALLE SIEMPREVIVA
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9840
Mailing Address - Country:US
Mailing Address - Phone:787-567-9007
Mailing Address - Fax:
Practice Address - Street 1:266 CALLE SIEMPREVIVA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9840
Practice Address - Country:US
Practice Address - Phone:787-567-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR736111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty