Provider Demographics
NPI:1912600388
Name:VIA QUIROPRACTICA LLC
Entity Type:Organization
Organization Name:VIA QUIROPRACTICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:ANAIS
Authorized Official - Last Name:LOPEZ CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:939-247-3968
Mailing Address - Street 1:155 AVE ARTERIAL HOSTOS APT 229
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2992
Mailing Address - Country:US
Mailing Address - Phone:939-247-3968
Mailing Address - Fax:
Practice Address - Street 1:GALERIA PASEOS 100 GRAND PASEO BOULEVARD LOCAL #105A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:939-247-3968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty