Basic Information
Provider Information | |||||||||
NPI: | 1376903914 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SAN JORGE CHIROPRACTIC SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | COND SAN JORGE | ||||||||
Address2: | 252 | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 009123302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877271000 | ||||||||
FaxNumber: | 7877273610 | ||||||||
Practice Location | |||||||||
Address1: | 253 CALLE SAN JORGE | ||||||||
Address2: | SAN JORGE CORPORATE BUILDING 2B | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 00912 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877271000 | ||||||||
FaxNumber: | 7872683610 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/24/2016 | ||||||||
LastUpdateDate: | 02/24/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NIEVES | ||||||||
AuthorizedOfficialFirstName: | AMAIRA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDIT MANAGER | ||||||||
AuthorizedOfficialTelephone: | 7877271000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SAN JORGE CHILDREN'S HOSPITAL, INC | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 64 | PR | Y |   | Hospitals | General Acute Care Hospital | Children |
No ID Information.