Provider Demographics
NPI:1104172162
Name:BIENESTAR QUIROPRACTICO CSP
Entity type:Organization
Organization Name:BIENESTAR QUIROPRACTICO CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QUIROPRACTICO
Authorized Official - Prefix:DR
Authorized Official - First Name:ISHI
Authorized Official - Middle Name:RF
Authorized Official - Last Name:RODRIGUEZ LORA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-565-1058
Mailing Address - Street 1:617 CALLE HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4370
Mailing Address - Country:US
Mailing Address - Phone:787-731-1575
Mailing Address - Fax:
Practice Address - Street 1:617 CALLE HILLSIDE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4370
Practice Address - Country:US
Practice Address - Phone:787-731-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty