Healthcare Provider Details

I. General information

NPI: 1730871658
Provider Name (Legal Business Name): SPINE PUERTO RICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE VIRTUD EDIFICIO GARCIA 1
PONCE PR
00730-3804
US

IV. Provider business mailing address

EXT. JACAGUAX 9 CALLE 1
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-9562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LUIS EUGENIO RIVERA IZQUIERDO
Title or Position: PRESIDENT
Credential: DC
Phone: 787-690-5972