Healthcare Provider Details

I. General information

NPI: 1174323786
Provider Name (Legal Business Name): DESERT RAIN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 LINDA VISTA RD
SANTA FE NM
87505-1630
US

IV. Provider business mailing address

1524 ESCONDIDA CT
SANTA FE NM
87507-5124
US

V. Phone/Fax

Practice location:
  • Phone: 505-500-2907
  • Fax:
Mailing address:
  • Phone: 503-806-7558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DYLAN BEAMER
Title or Position: PRESIDENT
Credential: DC
Phone: 503-806-7558