Healthcare Provider Details

I. General information

NPI: 1639396963
Provider Name (Legal Business Name): CHRIS R GALLEGOS D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6013 AZURE AVE NE
ALBUQUERQUE NM
87109-2626
US

IV. Provider business mailing address

PO BOX 35388
ALBUQUERQUE NM
87176-5388
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-4386
  • Fax: 505-559-4764
Mailing address:
  • Phone: 505-363-4386
  • Fax: 505-559-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: