Provider Demographics
NPI:1184404774
Name:SOUTHERN CHIROPRACTIC INCORPORATED
Entity type:Organization
Organization Name:SOUTHERN CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MAIZ-DEDOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-973-5151
Mailing Address - Street 1:PO BOX 560207
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-0207
Mailing Address - Country:US
Mailing Address - Phone:787-973-5151
Mailing Address - Fax:
Practice Address - Street 1:TORRE MEDICA SAN CRISTOBAL
Practice Address - Street 2:OFICINA 407C
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-973-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty