Healthcare Provider Details

I. General information

NPI: 1306145487
Provider Name (Legal Business Name): PLACITAS CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOMESTEADS RD SUITE F
PLACITAS NM
87043-9229
US

IV. Provider business mailing address

3 HOMESTEADS RD SUITE F
PLACITAS NM
87043-9229
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-3312
  • Fax:
Mailing address:
  • Phone: 505-620-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1744
License Number StateNM

VIII. Authorized Official

Name: DR. MARY LOU SKELTON
Title or Position: OWNER
Credential: D.C.
Phone: 505-620-3312