MEDICARE: INTEGRA QUIROPRACTICA LLC

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	:	1356039028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRA QUIROPRACTICA LLC

Provider Business Mailing Address
First Line	:	PO BOX 30811
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00929-1811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 CALLE 2B
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00985-5906
Country	:	US
Telephone Number	:	939-355-0155
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANAIRIS COLON RAMOS
Credential	:	DC
Telephone Number	:	939-355-0155

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	06/07/2023

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