Healthcare Provider Details

I. General information

NPI: 1285368118
Provider Name (Legal Business Name): OLIVIA GURULE-RIETMANN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date: 11/14/2022
Reactivation Date: 06/29/2023

III. Provider practice location address

2469 CORRALES RD STE E
CORRALES NM
87048-9148
US

IV. Provider business mailing address

5601 TIOGA RD NW
ALBUQUERQUE NM
87120-2352
US

V. Phone/Fax

Practice location:
  • Phone: 505-589-9571
  • Fax:
Mailing address:
  • Phone: 505-589-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC2289
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: