1497114524 NPI number — BACK TO THE GARDEN CHIROPRACTIC P.C.

Table of content: (NPI 1497114524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497114524 NPI number — BACK TO THE GARDEN CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK TO THE GARDEN CHIROPRACTIC P.C.
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:
1497114524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2053 AVE PEDRO ALBIZU CAMPOS
Provider Second Line Business Mailing Address:
SUITE 2, PMB 133
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603-5950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-819-3481
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 107 KM 1.3
Provider Second Line Business Practice Location Address:
EDIFICIO ROMAN 1
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-819-3481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FREY
Authorized Official First Name:
ASA
Authorized Official Middle Name:
REUBEN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-819-3481

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  000539 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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