Provider Demographics
NPI:1134878010
Name:COLON BALAGUER, JORGE O
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:O
Last Name:COLON BALAGUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 3387
Mailing Address - Street 2:
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670-9452
Mailing Address - Country:US
Mailing Address - Phone:787-604-4343
Mailing Address - Fax:
Practice Address - Street 1:131 CALLE 2
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965-5803
Practice Address - Country:US
Practice Address - Phone:787-946-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor