Healthcare Provider Details

I. General information

NPI: 1902134356
Provider Name (Legal Business Name): LEE F. PURCARO D.C. L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9004 MENAUL BLVD NE SUITE 9
ALBUQUERQUE NM
87112-2259
US

IV. Provider business mailing address

9004 MENAUL BLVD NE SUITE 9
ALBUQUERQUE NM
87112-2259
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-1090
  • Fax: 505-275-1090
Mailing address:
  • Phone: 505-275-1090
  • Fax: 505-275-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1242
License Number StateNM

VIII. Authorized Official

Name: DR. LEE F. PURCARO
Title or Position: OFFICER
Credential: D.C.
Phone: 505-275-1090