MEDICARE: CENTRO QUIROPRACTICO DE LA SALUD 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	:	1639506090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO QUIROPRACTICO DE LA SALUD LLC

Provider Business Mailing Address
First Line	:	PO BOX 8776
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00988-8776
Country	:	US
Telephone Number	:	787-750-1420
Fax Number	:	787-762-6119

Provider Business Practice Location Address
First Line	:	RL11 VIA 21
Second Line	:	VILLA FONTANA
City	:	CAROLINA
State	:	PR
Zip	:	00983-3946
Country	:	US
Telephone Number	:	787-750-1420
Fax Number	:	787-762-6119

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE A RODRIGUEZ-GONZALEZ
Credential	:
Telephone Number	:	787-750-1420

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	10/01/2013

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