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General NPI Number Information
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NPI Number | 1346743689
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Entity Type | Organization
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Legal Business Name | OPTIMUM PERFORMANCE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | E3178 PASEO CRESTA
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City | LEVITOWN
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-403-0703
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 363094
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City | SAN JUAN
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State | PR
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Zip | 00936-3094
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASISTENTE
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Name | MISS YOLANDA JIMENEZ CARRELO
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Credential |
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Telephone | 787-205-8564
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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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