Healthcare Provider Details

I. General information

NPI: 1295864122
Provider Name (Legal Business Name): SANDIA CHIROPRACTIC CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 SIERRA VISTA CT NE SUITE A
ALBUQUERQUE NM
87111-3422
US

IV. Provider business mailing address

9601 SIERRA VISTA CT NE SUITE A
ALBUQUERQUE NM
87111-3422
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4446
  • Fax: 505-275-8505
Mailing address:
  • Phone: 505-299-4446
  • Fax: 505-275-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1046
License Number StateNM

VIII. Authorized Official

Name: MRS. GRETCHEN G PETERSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 505-299-4446