MEDICARE: RENEE L. NIX DN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172P00000X	Naprapath	01010	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83-0429485	OTHER	NM	83-0429485

General Provider Information

NPI Number	:	1598150534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE L. NIX DN

Provider Business Mailing Address
First Line	:	1107 NIX LN
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-9435
Country	:	US
Telephone Number	:	505-690-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 BOTULPH RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5730
Country	:	US
Telephone Number	:	505-424-8990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	04/06/2015

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