=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437727187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROX CHIROPRACTIC AND REHABILITATION CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2021
-----------------------------------------------------
Last Update Date | 12/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7508 AVE SFC AGUSTIN RAMOS CALERO STE 1
-----------------------------------------------------
City | ISABELA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00662-5229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-699-6190
-----------------------------------------------------
Fax | 939-699-6143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7508 AVE SFC AGUSTIN RAMOS CALERO STE 1
-----------------------------------------------------
City | ISABELA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00662-5229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-699-6190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSE ANGEL CORCHADO PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-515-2876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------