Healthcare Provider Details

I. General information

NPI: 1396220448
Provider Name (Legal Business Name): EMMA-ROBY SUMMER DURLING DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 BARBARA LOOP SE STE C1
RIO RANCHO NM
87124-1068
US

IV. Provider business mailing address

1606 WESTERN HILLS DR SE
RIO RANCHO NM
87124-2489
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-3111
  • Fax: 888-289-9241
Mailing address:
  • Phone: 417-483-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC2186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: