Healthcare Provider Details

I. General information

NPI: 1740967603
Provider Name (Legal Business Name): JEAN LUIS SANTIAGO MIRANDA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE TENIENTE NELSON MARTINEZ URB ALTURAS DE FLAMBOYAN FF 18
BAYAMON PR
00959
US

IV. Provider business mailing address

URB VISTA DEL SOL B 16
COAMO PR
00769
US

V. Phone/Fax

Practice location:
  • Phone: 787-397-1614
  • Fax:
Mailing address:
  • Phone: 787-307-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010991
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1126
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1126
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: