=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588999452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRO QUIROPRACTICO DEL CARIBE C.S.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2009
-----------------------------------------------------
Last Update Date | 07/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 403 CALLE PEDRO ESPADA SUITE 1
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-306-5623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 403 CALLE PEDRO ESPADA SUITE 1
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-306-5623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MELISSA M GONZA;EZ
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 787-306-5623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 458
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------