MEDICARE: DR. CESAR A. IRIZARRY D.C.

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	111NN1001X	Nutrition Chiropractor	267	PR

General Provider Information

NPI Number	:	1538297718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CESAR A. IRIZARRY D.C.

Provider Business Mailing Address
First Line	:	#123 D STREET
Second Line	:	RAMEY BASE
City	:	AGUADILLA
State	:	PR
Zip	:	00603
Country	:	US
Telephone Number	:	787-890-0575
Fax Number	:	787-890-0575

Provider Business Practice Location Address
First Line	:	121 CALLE BELT
Second Line	:	RAMEY BASE
City	:	AGUADILLA
State	:	PR
Zip	:	00603-1105
Country	:	US
Telephone Number	:	787-890-0575
Fax Number	:	787-890-0575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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