Provider Demographics
NPI:1396790481
Name:LOPEZ-GARCIA, JUAN MANUEL (DC)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name:LOPEZ-GARCIA
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:P.O. BOX 366602
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6602
Mailing Address - Country:US
Mailing Address - Phone:787-734-2841
Mailing Address - Fax:787-713-0027
Practice Address - Street 1:JUNCOS PLAZA LOCAL 2A
Practice Address - Street 2:CARR PR-31 KM 24
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-2841
Practice Address - Fax:787-713-0027
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRV09322Medicare UPIN
PR0057856Medicare UPIN