Provider Demographics
NPI:1649294711
Name:SELLES, JESUS ENRIQUE (DC)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ENRIQUE
Last Name:SELLES
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:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-1267
Mailing Address - Country:US
Mailing Address - Phone:787-736-6757
Mailing Address - Fax:787-736-6680
Practice Address - Street 1:4 LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-6757
Practice Address - Fax:787-736-6757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRV-09030Medicare UPIN