Provider Demographics
NPI:1386706380
Name:CLINICA QUIROPRACTICA DR HECTOR R CARRASQUILLO CSP
Entity type:Organization
Organization Name:CLINICA QUIROPRACTICA DR HECTOR R CARRASQUILLO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARBELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-860-6373
Mailing Address - Street 1:54 CALLE CELIS AGUILERA N
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4811
Mailing Address - Country:US
Mailing Address - Phone:787-860-6373
Mailing Address - Fax:787-863-5454
Practice Address - Street 1:54 CALLE CELIS AGUILERA N
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4811
Practice Address - Country:US
Practice Address - Phone:787-860-6373
Practice Address - Fax:787-863-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty