MEDICARE: ADVANCE CHIROPRACTIC AND LASER CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1629699467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE CHIROPRACTIC AND LASER CLINIC LLC

Provider Business Mailing Address
First Line	:	BW7 113
Second Line	:	VALLE ARRIBA HEIGHTS
City	:	CAROLINA
State	:	PR
Zip	:	00983-3326
Country	:	US
Telephone Number	:	787-344-6695
Fax Number	:

Provider Business Practice Location Address
First Line	:	4ES4 VIA LETICIA
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00983-4807
Country	:	US
Telephone Number	:	787-257-5200
Fax Number	:

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. VICTOR M CRUZ
Credential	:	DC
Telephone Number	:	787-344-6695

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	05/04/2020

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