Provider Demographics
NPI:1184147639
Name:LIVE MOVEMENT CHIROPRACTIC & WELLNESS CLINIC PSC
Entity type:Organization
Organization Name:LIVE MOVEMENT CHIROPRACTIC & WELLNESS CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARRERAS RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-395-7555
Mailing Address - Street 1:AA3 CALLE 24
Mailing Address - Street 2:URB FLAMBOYAN GDNS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5803
Mailing Address - Country:US
Mailing Address - Phone:787-395-7555
Mailing Address - Fax:787-395-7556
Practice Address - Street 1:CALLE 24 AA3
Practice Address - Street 2:FLAMBOYAN GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5803
Practice Address - Country:US
Practice Address - Phone:787-395-7555
Practice Address - Fax:787-395-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty