Provider Demographics
NPI:1780375196
Name:AXIS SPINAL CARE, LLC
Entity type:Organization
Organization Name:AXIS SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-901-8717
Mailing Address - Street 1:PO BOX 8120
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2167 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0725
Practice Address - Country:US
Practice Address - Phone:787-901-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
599403120OtherCHIROPRACTOR