Healthcare Provider Details

I. General information

NPI: 1922394568
Provider Name (Legal Business Name): CHIROPRACTIC CLINICS OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESQUINA CALLE D Y E, BARRIO LOS FRAILES EDIFICIO CARIBBEAN CINEMAS STE 205
GUAYNABO PR
00969-4466
US

IV. Provider business mailing address

405 AVE ESMERALDA STE 102
GUAYNABO PR
00969-4466
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-7855
  • Fax:
Mailing address:
  • Phone: 787-790-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number453
License Number StatePR

VIII. Authorized Official

Name: DR. RUBEN VALDES
Title or Position: PRESIDENT
Credential: D.C.
Phone: 787-790-7855