Provider Demographics
NPI:1023343902
Name:CENTRO QUIROPRACTICO DEL PARQUE CSP
Entity type:Organization
Organization Name:CENTRO QUIROPRACTICO DEL PARQUE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SELLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-722-5422
Mailing Address - Street 1:146 CALLE DEL PARQUE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:UM
Mailing Address - Phone:787-722-5422
Mailing Address - Fax:787-721-5869
Practice Address - Street 1:146 CALLE DEL PARQUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1919
Practice Address - Country:US
Practice Address - Phone:787-722-5422
Practice Address - Fax:787-721-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty