Healthcare Provider Details

I. General information

NPI: 1285660407
Provider Name (Legal Business Name): FRANCESCA MICHELLE RUSSO-GOFORTH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SAN PEDRO NE SUITE A
ALBUQUERQUE NM
87110-3365
US

IV. Provider business mailing address

2730 SAN PEDRO NE SUITE A
ALBUQUERQUE NM
87110-3365
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 TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1413
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: