Provider Demographics
NPI:1356890545
Name:LOPEZ FELICIANO, JOSE ROBERTO (DC)
Entity type:Individual
Prefix:DR
First Name:JOSE ROBERTO
Middle Name:
Last Name:LOPEZ FELICIANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7769 NW 48TH ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5457
Mailing Address - Country:US
Mailing Address - Phone:786-801-3977
Mailing Address - Fax:
Practice Address - Street 1:7769 NW 48TH ST
Practice Address - Street 2:SUITE 180
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5457
Practice Address - Country:US
Practice Address - Phone:786-801-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11862111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition