Healthcare Provider Details

I. General information

NPI: 1114109774
Provider Name (Legal Business Name): ANTHONY DORION DELANGEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

1632 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-9444
  • Fax: 505-922-9150
Mailing address:
  • Phone: 505-922-9444
  • Fax: 505-922-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1713
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: