Healthcare Provider Details

I. General information

NPI: 1447413356
Provider Name (Legal Business Name): CORRALES CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4436 CORRALES RD
CORRALES NM
87048-2075
US

IV. Provider business mailing address

PO BOX 2075 4436 CORRALES RD
CORRALES NM
87048-2075
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-2273
  • Fax:
Mailing address:
  • Phone: 505-897-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number635
License Number StateNM

VIII. Authorized Official

Name: ROBERT A LUPOWITZ
Title or Position: PARTNER
Credential: D.C.
Phone: 505-897-2273