Provider Demographics
NPI:1548949118
Name:QUALITY LIFE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:QUALITY LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ONIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:939-339-2422
Mailing Address - Street 1:39 CALLE PEDRO PEREZ
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4516
Mailing Address - Country:US
Mailing Address - Phone:939-339-2422
Mailing Address - Fax:
Practice Address - Street 1:BO NARANJO CARR #2 KM 136.3
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:939-339-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty