Healthcare Provider Details

I. General information

NPI: 1669559258
Provider Name (Legal Business Name): GORDON BATTLE EATMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 LOS LOMAS CIR
CEDAR CREST NM
87008-9308
US

IV. Provider business mailing address

49 LOS LOMAS CIR
CEDAR CREST NM
87008-9308
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-8067
  • Fax: 505-286-8067
Mailing address:
  • Phone: 505-286-8067
  • Fax: 505-286-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number577
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: