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General NPI Number Information
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NPI Number | 1447611231
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Entity Type | Individual
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Provider Name | CAROLINE DE JESUS D.C.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | CALLE 16 L-8 URB. METROPOLIS
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 617-756-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 2841 W CAMPBELL RD
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City | LAKELAND
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State | FL
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Zip | 33810-1332
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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 |
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Name |
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Credential |
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Telephone |
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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 | 11772
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License Number State | FL
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