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General NPI Number Information
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NPI Number | 1235933664
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Entity Type | Organization
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Legal Business Name | SAN JUAN WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | URB. REPARTO AMERICA 521 CALLE BARRANQUITAS
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City | SAN JUAN
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State | PR
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Zip | 00923
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Country | US
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Telephone | 787-528-0713
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Fax |
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Provider Business Mailing Address
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Address Line | 560 CALLE NAPOLES COND CONCORDIA GARDENS 2 APT.16E
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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 | 787-616-7630
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MARCOS LOPEZ
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Credential | DC
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Telephone | 787-616-7630
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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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