Healthcare Provider Details

I. General information

NPI: 1275468043
Provider Name (Legal Business Name): BRAVE BODY CHIROPRACTIC BOUTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 AVE PONCE DE LEON STE G4
SAN JUAN PR
00918-1012
US

IV. Provider business mailing address

818 CALLE ASABACHE
SAN JUAN PR
00926-5821
US

V. Phone/Fax

Practice location:
  • Phone: 787-308-7868
  • Fax:
Mailing address:
  • Phone: 787-308-7868
  • 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. ANGELICA M TRINIDAD
Title or Position: OWNER & CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 787-308-7868