Provider Demographics
NPI:1871310227
Name:FUNCTIONAL SPINE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FUNCTIONAL SPINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN X
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-309-4828
Mailing Address - Street 1:56 CALLE PADRE PEREZ
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DOCTOR'S CENTER 27 CALLE PERAL
Practice Address - Street 2:OFFICE 201-202
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-309-4828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty