Healthcare Provider Details

I. General information

NPI: 1609510528
Provider Name (Legal Business Name): MIQUIROPRACTICOPR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 AVE VCTR LABIOSA STE 106
SAN JUAN PR
00926-4149
US

IV. Provider business mailing address

6981 CARR 187 APT 15A
CAROLINA PR
00979-7057
US

V. Phone/Fax

Practice location:
  • Phone: 787-223-9160
  • Fax:
Mailing address:
  • Phone: 787-667-5898
  • 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. JULIE S MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-667-5711