Healthcare Provider Details

I. General information

NPI: 1609991264
Provider Name (Legal Business Name): REGINALD G DE PELICHY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 02/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ORTIZ DR NE
ALBUQUERQUE NM
87108-1446
US

IV. Provider business mailing address

41 CAMINO EL ALTO NE
ALBUQUERQUE NM
87123-9570
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-0297
  • Fax: 505-266-8622
Mailing address:
  • Phone: 505-292-4859
  • Fax: 505-293-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number424
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number424
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: