Healthcare Provider Details

I. General information

NPI: 1982067906
Provider Name (Legal Business Name): PASSALACQUA CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17713 US 84/285
SANTA FE NM
87506-2668
US

IV. Provider business mailing address

40 TANGO RD
SANTA FE NM
87506-7148
US

V. Phone/Fax

Practice location:
  • Phone: 505-455-9909
  • Fax: 505-455-9919
Mailing address:
  • Phone: 505-455-9909
  • Fax: 505-455-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1635
License Number StateNM

VIII. Authorized Official

Name: DR. DAMIEN SALVATORE PASSALACQUA
Title or Position: OWNER
Credential: D.C.
Phone: 505-455-9909