Healthcare Provider Details

I. General information

NPI: 1659824795
Provider Name (Legal Business Name): JADEN AMARO DC, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13505 PIERCE ARROW RD NE
ALBUQUERQUE NM
87112-6228
US

IV. Provider business mailing address

13505 PIERCE ARROW RD NE
ALBUQUERQUE NM
87112-6228
US

V. Phone/Fax

Practice location:
  • Phone: 575-626-9363
  • Fax:
Mailing address:
  • Phone: 575-626-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number510640195
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: