Healthcare Provider Details

I. General information

NPI: 1447127857
Provider Name (Legal Business Name): MANUAL MEDICINE REHABILITATION & RESEARCH, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 LEXINGTON RD
CLOVIS NM
88101-4466
US

IV. Provider business mailing address

811 LEXINGTON RD
CLOVIS NM
88101-4466
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-6677
  • Fax: 575-616-7016
Mailing address:
  • Phone: 575-935-6677
  • Fax: 575-616-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXJANDRO C DAVIANO
Title or Position: MEDICAL DIRECTOR
Credential: DN, DO, DRPH, MS, MP
Phone: 575-935-6677