Healthcare Provider Details

I. General information

NPI: 1962321133
Provider Name (Legal Business Name): FANNAITSE CHIROPRACTIC MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 101 KM 16.3 BO. LAS ARENAS BOQUERON
CABO ROJO PR
00622
US

IV. Provider business mailing address

PO BOX 1368
CABO ROJO PR
00623-1368
US

V. Phone/Fax

Practice location:
  • Phone: 787-647-3511
  • Fax:
Mailing address:
  • Phone: 787-647-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOSE A CRUZ TROCHE
Title or Position: PRESIDENT
Credential:
Phone: 787-647-3511