=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306317300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICA QUIROPRACTICA DRA. BLANCO MARTINEZ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2018
-----------------------------------------------------
Last Update Date | 12/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 CALLE JUAN J JIMENEZ
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-200-5942
-----------------------------------------------------
Fax | 787-200-5943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 CALLE JUAN J JIMENEZ
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-200-5942
-----------------------------------------------------
Fax | 787-200-5943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | ARLEEN CRISTINA BLANCO- MARTINEZ
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 787-200-5942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------