Healthcare Provider Details

I. General information

NPI: 1124369947
Provider Name (Legal Business Name): RION MARCUS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 MONTGOMERY BLVD NE BUILDING 1, SUITE 30
ALBUQUERQUE NM
87111-3857
US

IV. Provider business mailing address

4509 SAN ANDRES AVE NE
ALBUQUERQUE NM
87110-1125
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-6622
  • Fax:
Mailing address:
  • Phone: 505-615-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2064
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: