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General NPI Number Information
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NPI Number | 1275735136
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Entity Type | Organization
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Legal Business Name | CONSORCIO QUIROPRACTICO INC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 1509 AVE JESUS T PINERO
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City | SAN JUAN
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State | PR
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Zip | 00920-5404
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Country | US
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Telephone | 787-792-2254
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Fax | 787-792-1795
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Provider Business Mailing Address
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Address Line | 1509 AVE JESUS T PINERO
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City | SAN JUAN
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State | PR
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Zip | 00920-5404
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Country | US
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Telephone | 787-792-2254
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Fax | 787-792-1795
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Authorized Official
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Title or Position | OWNER
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Name | GLORIMAR SERRANO
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Credential | D.C.
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Telephone | 787-792-2254
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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 | 341
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License Number State | PR
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