Healthcare Provider Details

I. General information

NPI: 1659420164
Provider Name (Legal Business Name): CHRISTINE PATRICIA BARANOWSKI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 RODEO PARK DR E BLDG #3
SANTA FE NM
87505-6313
US

IV. Provider business mailing address

3 HUNTERS PASS
SANTA FE NM
87508-4815
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-8555
  • Fax:
Mailing address:
  • Phone: 505-424-3976
  • Fax: 505-424-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1624
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: