Healthcare Provider Details

I. General information

NPI: 1871623272
Provider Name (Legal Business Name): KACPER FIUTEK PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE RD NE SUITE I
ALBUQUERQUE NM
87107-4546
US

IV. Provider business mailing address

3500 COMANCHE RD NE STE I
ALBUQUERQUE NM
87107-4546
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-0771
  • Fax: 505-884-0776
Mailing address:
  • Phone: 505-884-0771
  • Fax: 505-884-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number823
License Number StateNM

VIII. Authorized Official

Name: DR. KACPER FIUTEK
Title or Position: PRESIDENT
Credential: DC
Phone: 505-884-0771