Healthcare Provider Details

I. General information

NPI: 1134528193
Provider Name (Legal Business Name): RIO GRANDE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 ALAMEDA BLVD NW STE C
ALBUQUERQUE NM
87114-1240
US

IV. Provider business mailing address

1127 ALAMEDA BLVD NW STE C
ALBUQUERQUE NM
87114-1240
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-4632
  • Fax:
Mailing address:
  • Phone: 505-433-4632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1979
License Number StateNM

VIII. Authorized Official

Name: MICHAEL CAPOBIANCO
Title or Position: PARTNER
Credential: DC
Phone: 330-361-9455