MEDICARE: DR. LAURA E JIMENEZ DC

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	375PR	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100225	OTHER	PR	LA CRUZ AZUL DE PR
2	9590134	OTHER	PR	HUMANA INSURANCE
3	68040	OTHER	PR	TRIPLE S

General Provider Information

NPI Number	:	1689641003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA E JIMENEZ DC

Provider Business Mailing Address
First Line	:	PASEO LAS CUMBRES
Second Line	:	349 AVE FELISA R DE GAUTIER STE.207
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6673
Country	:	US
Telephone Number	:	787-625-0707
Fax Number	:	787-625-0705

Provider Business Practice Location Address
First Line	:	PASEO LAS CUMBRES
Second Line	:	349 AVE FELISA R DE GAUTIER STE.207
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6673
Country	:	US
Telephone Number	:	787-625-0707
Fax Number	:	787-625-0705

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LAURA E JIMENEZ DC” Practice Location

Language	Start Address	Practice Location

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