Healthcare Provider Details

I. General information

NPI: 1235929183
Provider Name (Legal Business Name): KSMLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO NOVIOS PLAZA AVE. HOSTOS SUITE 204
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 140182
ARECIBO PR
00614-0182
US

V. Phone/Fax

Practice location:
  • Phone: 787-450-9601
  • Fax:
Mailing address:
  • Phone: 787-450-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: KENNETH LOUIS DE JESUS TORRES
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 787-450-9601