Healthcare Provider Details

I. General information

NPI: 1992634208
Provider Name (Legal Business Name): SPINE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CALLE SGTO I MALARET JUARBE
UTUADO PR
00641-3028
US

IV. Provider business mailing address

PO BOX 810
GARROCHALES PR
00652-0810
US

V. Phone/Fax

Practice location:
  • Phone: 813-834-1688
  • Fax:
Mailing address:
  • Phone: 813-834-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. ALBERTO MARTINEZ CUEVAS
Title or Position: OWNER
Credential: MD
Phone: 813-834-1688