Provider Demographics
NPI:1104646413
Name:LABRADOR CACHO, JESUS RAFAEL (DC)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:RAFAEL
Last Name:LABRADOR CACHO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JESUS
Other - Middle Name:R
Other - Last Name:LABRADOR CACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 COND LOMAS DE RIO GRANDE
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-8702
Mailing Address - Country:US
Mailing Address - Phone:787-552-0109
Mailing Address - Fax:
Practice Address - Street 1:DOS CUERDAS, CARR #3 KM 19.9 BARRIO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-221-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor