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General NPI Number Information
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NPI Number | 1114461613
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Entity Type | Organization
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Legal Business Name | QUIROPRACTIVE LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 1194 CALLE NICOLAS AGUAYO
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 939-337-0239
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Fax |
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Provider Business Mailing Address
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Address Line | B10 CALLE MAGNOLIA URB EL DORADO
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-864-3718
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Fax |
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Authorized Official
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Title or Position | QUIROPRACTOR
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Name | ALEXIS EDGARDO VALENTIN
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Credential | D.C.
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Telephone | 787-424-8541
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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 | 00547
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License Number State | PR
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