=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760178123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OS CHIROPRACTIC STUDIO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2023
-----------------------------------------------------
Last Update Date | 04/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAR PR-19 KM 0.4 AV. LUIS VIGOREAUX
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-425-1799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 AVE ESMERALDA STE 2667
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-4427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-425-1799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ADRIANA MADERA
-----------------------------------------------------
Credential | CHIROPRACTOR
-----------------------------------------------------
Telephone | 787-425-1799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------