Provider Demographics
NPI:1992954796
Name:ADVANCE CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:ADVANCE CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-344-6695
Mailing Address - Street 1:VALLE ARRIBA HEIGHT
Mailing Address - Street 2:BW-7, 113 ST
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3326
Mailing Address - Country:US
Mailing Address - Phone:787-344-6695
Mailing Address - Fax:
Practice Address - Street 1:AVE FIDALGO DIAZ, VILLA FONTANA BL-2
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-257-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR433261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center