Healthcare Provider Details

I. General information

NPI: 1770403636
Provider Name (Legal Business Name): EQUILIBRIO VERTEBRAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO HATO ARRIBA CARR 111 KM 14.3
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 4 BOX 16450
MOCA PR
00676-9663
US

V. Phone/Fax

Practice location:
  • Phone: 787-240-1980
  • 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: NISHKA MARIE MEDINA MONTALVO
Title or Position: OWNER
Credential: DC
Phone: 787-240-1980