Healthcare Provider Details

I. General information

NPI: 1003746512
Provider Name (Legal Business Name): PAINTED SKIES CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAIN AVE
PORTALES NM
88130-6216
US

IV. Provider business mailing address

203 S MAIN AVE # 161
PORTALES NM
88130-6216
US

V. Phone/Fax

Practice location:
  • Phone: 575-226-4330
  • Fax:
Mailing address:
  • Phone: 575-226-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: NATHANIEL FLORES
Title or Position: OWNER
Credential: D.C.
Phone: 575-226-4330