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General NPI Number Information
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NPI Number | 1003390261
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Entity Type | Individual
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Provider Name | JOSE RAFAEL NIEVES-LOPEZ DC
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Gender | Male
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Dates
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Enumeration Date | 09/23/2018
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | CARRETERA PR 402 KM 2.9 BARRIO QUEBRADA LARGA LOCAL #6
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City | ANASCO
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State | PR
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Zip | 00610
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Country | US
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Telephone | 787-464-0184
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Fax |
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Provider Business Mailing Address
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Address Line | 166 CALLE CONFRATERNIDAD
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City | MAYAGUEZ
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State | PR
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Zip | 00680-6215
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Country | US
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Telephone | 787-464-0184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 655
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License Number State | PR
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