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General NPI Number Information
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NPI Number | 1275962094
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Entity Type | Organization
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Legal Business Name | LIFESTYLE CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 89 AVE DE DIEGO
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City | SAN JUAN
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State | PR
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Zip | 00927-6372
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Country | US
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Telephone | 787-764-2683
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 367768
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City | SAN JUAN
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State | PR
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Zip | 00936-7768
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Country | US
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Telephone | 787-565-7342
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. PATRICIA JIMENEZ BARALT
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Credential | D.C.
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Telephone | 787-565-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 521
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License Number State | PR
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