Provider Demographics
NPI:1790521565
Name:IMMANIS DIGNUS LLC
Entity type:Organization
Organization Name:IMMANIS DIGNUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYLIN
Authorized Official - Middle Name:AIXA
Authorized Official - Last Name:GARCIA LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-427-8313
Mailing Address - Street 1:HC 57 BOX 9702
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9715
Mailing Address - Country:US
Mailing Address - Phone:787-427-8313
Mailing Address - Fax:
Practice Address - Street 1:CARR 115 BO CALVACHE KM 14.1
Practice Address - Street 2:LOCAL 4
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:787-456-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty