Healthcare Provider Details

I. General information

NPI: 1710424650
Provider Name (Legal Business Name): JOLENE ALISANDRA ARAGON-ROSALES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOLENE ALISANDRA ARAGON

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841B US HIGHWAY 66
EDGEWOOD NM
87015-6784
US

IV. Provider business mailing address

1841B US HIGHWAY 66
EDGEWOOD NM
87015-6784
US

V. Phone/Fax

Practice location:
  • Phone: 505-926-9300
  • Fax:
Mailing address:
  • Phone: 505-926-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: