Provider Demographics
NPI:1326854712
Name:JR CHIROPRACTIC MANAGEMENT GROUP, CSP
Entity type:Organization
Organization Name:JR CHIROPRACTIC MANAGEMENT GROUP, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:CRUZ TROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-647-3511
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1368
Mailing Address - Country:US
Mailing Address - Phone:787-647-3511
Mailing Address - Fax:
Practice Address - Street 1:CENTRO PROFESIONAL DEL SUR CARR 121 KM. 13
Practice Address - Street 2:SECTOR CUATRO CALLES SUSUA BAJA
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-992-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty