Provider Demographics
NPI:1174107627
Name:VIVO CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:VIVO CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DEL MAR
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-619-5790
Mailing Address - Street 1:URB. JARDINES DE CAPARRA
Mailing Address - Street 2:CALLE 7 E19
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-619-5790
Mailing Address - Fax:
Practice Address - Street 1:CARR 643 KM 13.8 SUITE 172
Practice Address - Street 2:BO BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-619-5790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty