MEDICARE: MRS. XENIA MEDINA-ROQUE 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	295	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7310384	OTHER	HUMANA
2	5473	OTHER	IMC
3	601609	OTHER	MMM
4	233007	OTHER	PREFERRED
5	35105	OTHER	SSS

General Provider Information

NPI Number	:	1952395857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. XENIA MEDINA-ROQUE DC

Provider Business Mailing Address
First Line	:	37 MENDEZ VIGO
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00731
Country	:	US
Telephone Number	:	787-848-6539
Fax Number	:	787-848-6539

Provider Business Practice Location Address
First Line	:	37 MENDEZ VIGO
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00731
Country	:	US
Telephone Number	:	787-848-6539
Fax Number	:	787-848-6539

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. XENIA MEDINA-ROQUE DC” Practice Location

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