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General NPI Number Information
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NPI Number | 1942037437
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Entity Type | Organization
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Legal Business Name | REAWAKEN UPPER CERVICAL CHIROPRACTIC
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 09/22/2024
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Provider Practice Location Address
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Address Line | 437 AVE. HOSTOS LOCAL 1
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-758-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 CALLE OZAMA
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City | SAN JUAN
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State | PR
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Zip | 00926-2902
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Country | US
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Telephone | 787-630-2611
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EMILIO F JIMENEZ
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Credential | DC
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Telephone | 787-630-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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