Healthcare Provider Details

I. General information

NPI: 1902798523
Provider Name (Legal Business Name): THE CARNELIAN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 NM STATE RD 75
DIXON NM
87527
US

IV. Provider business mailing address

PO BOX 452
DIXON NM
87527-0452
US

V. Phone/Fax

Practice location:
  • Phone: 505-579-9630
  • Fax: 505-930-7989
Mailing address:
  • Phone: 505-579-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIA CHILTON
Title or Position: BOARD PRESIDENT
Credential:
Phone: 505-901-1272