Healthcare Provider Details

I. General information

NPI: 1760968440
Provider Name (Legal Business Name): ROSS CLOUD HALL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRANKLIN AVE
SANTA FE NM
87501-3617
US

IV. Provider business mailing address

507 WEBBER ST
SANTA FE NM
87505-2653
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-3727
  • Fax:
Mailing address:
  • Phone: 505-819-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2170
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: