Provider Demographics
NPI:1720843600
Name:ESSENTIAL CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMAR
Authorized Official - Middle Name:OMY
Authorized Official - Last Name:RIOS - RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-987-8710
Mailing Address - Street 1:1805 PASEO LA COLONIA STE 3
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2253
Mailing Address - Country:US
Mailing Address - Phone:787-987-8710
Mailing Address - Fax:
Practice Address - Street 1:1805 PASEO LA COLONIA STE 3
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2253
Practice Address - Country:US
Practice Address - Phone:787-987-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty