Healthcare Provider Details

I. General information

NPI: 1336681840
Provider Name (Legal Business Name): MUSCULOSKELETAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 09/14/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 TRINITY DR STE C5
LOS ALAMOS NM
87544-2221
US

IV. Provider business mailing address

3500 TRINITY DR STE C5
LOS ALAMOS NM
87544-2221
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-4061
  • Fax:
Mailing address:
  • Phone: 505-412-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TAYLOR DIMARINO
Title or Position: NAPRAPATH
Credential: DN
Phone: 505-412-4061