Healthcare Provider Details

I. General information

NPI: 1003040973
Provider Name (Legal Business Name): BRENDAN TUCKER CASEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 03/23/2024
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRANKLIN AVE
SANTA FE NM
87501-3617
US

IV. Provider business mailing address

501 FRANKLIN AVE
SANTA FE NM
87501
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-1873
  • Fax:
Mailing address:
  • Phone: 505-690-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2174
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: