Provider Demographics
NPI:1912009457
Name:SIVERIO CASANOVA, ELVIN J (DC)
Entity Type:Individual
Prefix:
First Name:ELVIN
Middle Name:J
Last Name:SIVERIO CASANOVA
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 1:1566 CALLE BORI
Mailing Address - Street 2:URB. CARIBE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6113
Mailing Address - Country:US
Mailing Address - Phone:787-764-5879
Mailing Address - Fax:787-763-8012
Practice Address - Street 1:1566 CALLE BORI
Practice Address - Street 2:URB. CARIBE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6113
Practice Address - Country:US
Practice Address - Phone:787-764-5879
Practice Address - Fax:787-763-8012
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR327111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR35114Medicare ID - Type Unspecified
PR65771Medicare UPIN