=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316515059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINESIS HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2021
-----------------------------------------------------
Last Update Date | 06/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR #2, KM 96 HECTOMETRO #2 BO. COCOS
-----------------------------------------------------
City | QUEBRADILLAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-396-9648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 437
-----------------------------------------------------
City | ISABELA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00662-0437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-396-9648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. XAVIER O BARRETO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 787-396-9648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------