Healthcare Provider Details

I. General information

NPI: 1356555262
Provider Name (Legal Business Name): COLONIAS CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 STATE HWY 150 SUITE #7
EL PRADO NM
87529
US

IV. Provider business mailing address

PO BOX 1589
EL PRADO NM
87529-1589
US

V. Phone/Fax

Practice location:
  • Phone: 575-776-1117
  • Fax: 575-776-1119
Mailing address:
  • Phone: 575-776-1117
  • Fax: 575-776-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1149
License Number StateNM

VIII. Authorized Official

Name: LUCY WHYTE FERGUSON
Title or Position: OWNER
Credential: D.C.
Phone: 505-776-1117