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General NPI Number Information
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NPI Number | 1851737605
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Entity Type | Organization
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Legal Business Name | FITSPINE CLINIC LLC
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | AVE ROOSEVELT 1445 RESOLUCION 33 DORAL BANK PLAZA PRIMER NIVEL
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City | SAN JUAN
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State | PR
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Zip | 00920
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Country | US
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Telephone | 787-706-1763
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Fax |
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Provider Business Mailing Address
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Address Line | 47 CALISTEMON ESTANCIAS DE TORRIMAR
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City | GUAYNABO
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State | PR
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Zip | 00966
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Country | US
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Telephone | 787-706-1763
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JOSE I CALBETO VAILLANT
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Credential | D.C
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Telephone | 787-706-1763
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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 | 432
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License Number State | PR
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