Provider Demographics
NPI:1194497867
Name:CHIROPRACTIC RADIOLOGY IMAGING LLC
Entity type:Organization
Organization Name:CHIROPRACTIC RADIOLOGY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANYSHA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:FLORES GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:407-223-1372
Mailing Address - Street 1:URB. ALTURAS DE COAMO
Mailing Address - Street 2:227 CALLE CALIZA
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4807
Mailing Address - Country:US
Mailing Address - Phone:787-238-6030
Mailing Address - Fax:
Practice Address - Street 1:CARR.14 KM.31.5 BARRIO SAN ILDEFONSO
Practice Address - Street 2:BOULEVARD PIEL CANELA SUITE#3
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-238-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty