Healthcare Provider Details

I. General information

NPI: 1124022157
Provider Name (Legal Business Name): LONNIE L PEETS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 BARBARA LOOP SE STE C-1
RIO RANCHO NM
87124-1068
US

IV. Provider business mailing address

4111 BARBARA LOOP SE STE C-1
RIO RANCHO NM
87124-1068
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-3111
  • Fax: 888-289-9241
Mailing address:
  • Phone: 505-891-3111
  • Fax: 888-289-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1071
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: