1174999569 NPI number — VIDA INTEGRAL CENTRO QUIROPRACTICO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174999569 NPI number — VIDA INTEGRAL CENTRO QUIROPRACTICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIDA INTEGRAL CENTRO QUIROPRACTICO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174999569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11655
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-210-9705
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
252 CALLE SAN JOSE
Provider Second Line Business Practice Location Address:
STE 2A
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-721-8432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MIRANDA COLON
Authorized Official First Name:
RAMON
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT/TREASURER
Authorized Official Telephone Number:
787-210-9705

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com