Healthcare Provider Details

I. General information

NPI: 1124084348
Provider Name (Legal Business Name): DEAN C WASSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 GOLF COURSE RD SE STE. C
RIO RANCHO NM
87124-1956
US

IV. Provider business mailing address

1511 GOLF COURSE RD SE STE. C
RIO RANCHO NM
87124-1956
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-8600
  • Fax: 505-933-8601
Mailing address:
  • Phone: 505-933-8600
  • Fax: 505-933-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1664
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: