Healthcare Provider Details

I. General information

NPI: 1013246768
Provider Name (Legal Business Name): ATLAS ORTHOGONAL CHIROPRACTIC OF ALBUQUERQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SAN PEDRO NE SUITE A
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

2730 SAN PEDRO NE SUITE A
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-0650
  • Fax: 505-881-0647
Mailing address:
  • Phone: 505-881-0650
  • Fax: 505-881-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1750
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1413
License Number StateNM

VIII. Authorized Official

Name: FRANCESCA MICHELLE RUSSO-GOFORTH
Title or Position: CHIROPRACTOR/MANAGER
Credential: D.C.
Phone: 505-881-0650