Healthcare Provider Details

I. General information

NPI: 1134043979
Provider Name (Legal Business Name): MODERN SPINE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 AVE MUNOZ RIVERA SUITE 1
PONCE PR
00717
US

IV. Provider business mailing address

URB LAS ALONDRAS A10 CALLE 1
VILLALBA PR
00766
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-1271
  • Fax: 787-842-7610
Mailing address:
  • Phone: 787-841-1271
  • Fax: 787-842-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL MANUEL MIRANDA
Title or Position: CLINIC DIRECTOR/OWNER
Credential: DC
Phone: 787-486-7919