Healthcare Provider Details

I. General information

NPI: 1194497867
Provider Name (Legal Business Name): CHIROPRACTIC RADIOLOGY IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR.14 KM.31.5 BARRIO SAN ILDEFONSO BOULEVARD PIEL CANELA SUITE#3
COAMO PR
00769
US

IV. Provider business mailing address

URB. ALTURAS DE COAMO 227 CALLE CALIZA
COAMO PR
00769-4807
US

V. Phone/Fax

Practice location:
  • Phone: 787-238-6030
  • Fax:
Mailing address:
  • Phone: 787-238-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANYSHA YVETTE FLORES GONZALEZ
Title or Position: PRESIDENT
Credential: MPH
Phone: 407-223-1372