Healthcare Provider Details

I. General information

NPI: 1538324421
Provider Name (Legal Business Name): DUCASSE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 1ST ST SUITE B
GRANTS NM
87020-2703
US

IV. Provider business mailing address

PO BOX 540
GRANTS NM
87020-0540
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-5377
  • Fax: 505-287-5508
Mailing address:
  • Phone: 505-287-5377
  • Fax: 505-287-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1749
License Number StateNM

VIII. Authorized Official

Name: DR. ROSE A DUCASSE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 505-287-5377