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General NPI Number Information
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NPI Number | 1336933399
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Entity Type | Organization
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Legal Business Name | WAVE SPORTS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | G3 CALLE ONEILL STE 3
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City | SAN JUAN
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State | PR
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Zip | 00918-2361
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Country | US
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Telephone | 787-909-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 AVE PONCE DE LEON APT 1181
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City | SAN JUAN
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State | PR
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Zip | 00909-1797
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Country | US
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Telephone | 470-899-9800
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL / OWNER
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Name | DR. JAVIER E CORNIER BLANCO
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Credential | DC
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Telephone | 470-899-9800
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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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