Healthcare Provider Details

I. General information

NPI: 1730210063
Provider Name (Legal Business Name): MELANIE DAELO BUENVIAJE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RODEO LN STE D2
SANTA FE NM
87507-5803
US

IV. Provider business mailing address

3600 RODEO LN STE D2
SANTA FE NM
87507-5803
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-0821
  • Fax: 505-984-0168
Mailing address:
  • Phone: 505-984-0821
  • Fax: 505-984-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1548
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: