Healthcare Provider Details

I. General information

NPI: 1740158401
Provider Name (Legal Business Name): IAN DEL MUNDO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 ACADEMY RD NE APT 1517
ALBUQUERQUE NM
87111-7334
US

IV. Provider business mailing address

10700 ACADEMY RD NE APT 1517
ALBUQUERQUE NM
87111-7334
US

V. Phone/Fax

Practice location:
  • Phone: 386-299-7697
  • Fax:
Mailing address:
  • Phone: 386-299-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-2025-0028
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: