Healthcare Provider Details

I. General information

NPI: 1780003004
Provider Name (Legal Business Name): DOMINIC GUTIERREZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WINTER HAVEN DR NW SUITE H
ALBUQUERQUE NM
87120-1745
US

IV. Provider business mailing address

6001 WINTER HAVEN DR NW SUITE H
ALBUQUERQUE NM
87120-1745
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-9000
  • Fax:
Mailing address:
  • Phone: 505-724-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2066
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: