Healthcare Provider Details

I. General information

NPI: 1588034490
Provider Name (Legal Business Name): STEPHEN LEGATE DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 ACADEMY RD NE SUITE C
ALBUQUERQUE NM
87109-3386
US

IV. Provider business mailing address

6751 ACADEMY RD NE SUITE C
ALBUQUERQUE NM
87109-3386
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-2900
  • Fax:
Mailing address:
  • Phone: 505-414-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2078
License Number StateNM

VIII. Authorized Official

Name: STEPHEN MARK LEGATE
Title or Position: CEO
Credential: DC
Phone: 505-414-2900