Provider Demographics
NPI:1699106823
Name:GRUPO QUIROPRACTICO INDALO CSP
Entity type:Organization
Organization Name:GRUPO QUIROPRACTICO INDALO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:EDEL
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-759-9605
Mailing Address - Street 1:508 CALLE CESAR GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2652
Mailing Address - Country:US
Mailing Address - Phone:787-759-9605
Mailing Address - Fax:787-754-6958
Practice Address - Street 1:508 CALLE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2652
Practice Address - Country:US
Practice Address - Phone:787-759-9605
Practice Address - Fax:787-754-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0270111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty