Healthcare Provider Details

I. General information

NPI: 1760605885
Provider Name (Legal Business Name): ESPANOLA FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 S RIVERSIDE DR STE A1
ESPANOLA NM
87532-2980
US

IV. Provider business mailing address

423 S RIVERSIDE DR STE A1
ESPANOLA NM
87532-2980
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-3001
  • Fax: 505-753-3052
Mailing address:
  • Phone: 505-753-3001
  • Fax: 505-753-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1497
License Number StateNM

VIII. Authorized Official

Name: JOHN MICHAEL FOX
Title or Position: PRESIDENT
Credential: DC
Phone: 505-753-3001