MEDICARE: BRAVE BODY CHIROPRACTIC BOUTIQUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1275468043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVE BODY CHIROPRACTIC BOUTIQUE

Provider Business Mailing Address
First Line	:	818 CALLE ASABACHE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5821
Country	:	US
Telephone Number	:	787-308-7868
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 AVE PONCE DE LEON STE G4
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-1012
Country	:	US
Telephone Number	:	787-308-7868
Fax Number	:

Authorized Official
Title or Position	:	OWNER & CHIROPRACTIC PHYSICIAN
Name	:	DR. ANGELICA M TRINIDAD
Credential	:	DC
Telephone Number	:	787-308-7868

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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