Provider Demographics
NPI:1215760202
Name:CORNIER BLANCO, JAVIER E (DC)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:E
Last Name:CORNIER BLANCO
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 AVE PONCE DE LEON APT 1181
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1797
Mailing Address - Country:US
Mailing Address - Phone:470-899-9800
Mailing Address - Fax:
Practice Address - Street 1:G3 CALLE ONEILL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2360
Practice Address - Country:US
Practice Address - Phone:787-909-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011226111N00000X
PR1043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor