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General NPI Number Information
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NPI Number | 1114785060
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Entity Type | Organization
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Legal Business Name | ENDURO CHIROPRACTIC & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 1241 AVE HOSTOS
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City | PONCE
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State | PR
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Zip | 00717-0943
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Country | US
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Telephone | 787-298-4516
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Fax |
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Provider Business Mailing Address
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Address Line | URB JARDINES DEL CARIBE 00-36 CALLE 49
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City | PONCE
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State | PR
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Zip | 00728
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Country | US
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Telephone | 787-298-4516
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Fax |
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Authorized Official
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Title or Position | AUTORIZED PERSON
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Name | IVAN G. RODRIGUEZ TORRES - RICCI N. GONZALEZ MEDINA
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Credential | BS, DC
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Telephone | 787-298-4516
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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 |
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License Number State |
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