Healthcare Provider Details

I. General information

NPI: 1003221003
Provider Name (Legal Business Name): CENTRO QUIROPRACTICO JOSE BOBONIS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21-26 CARR 174 STA ROSA
BAYAMON PR
00959-6512
US

IV. Provider business mailing address

21-26 CARR 174
BAYAMON PR
00959-6512
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-2447
  • Fax: 787-269-2484
Mailing address:
  • Phone: 787-269-2447
  • Fax: 787-269-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number373
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE BOBONIS
Title or Position: PRESIDENT
Credential: D.C
Phone: 787-269-2447