Healthcare Provider Details

I. General information

NPI: 1770042319
Provider Name (Legal Business Name): MIGUEL ALEXIS CARBONELL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. SIMON MADERA PARCELAS FALU, #11, EDIFICIO B, LOCAL 4
SAN JUAN PR
00924
US

IV. Provider business mailing address

HC 2 BOX 14482
CAROLINA PR
00987-9719
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-3437
  • Fax:
Mailing address:
  • Phone: 787-400-8832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number673
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: