Healthcare Provider Details

I. General information

NPI: 1811628019
Provider Name (Legal Business Name): TURQUOISE TRAIL THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 10/05/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 S SAINT FRANCIS DR STE E
SANTA FE NM
87505-3097
US

IV. Provider business mailing address

906 S SAINT FRANCIS DR STE E
SANTA FE NM
87505-3097
US

V. Phone/Fax

Practice location:
  • Phone: 505-303-0262
  • Fax: 505-393-8545
Mailing address:
  • Phone: 505-303-0262
  • Fax: 505-393-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRENDAN T CASEY
Title or Position: OWNER/DOCTOR
Credential: DC
Phone: 505-690-1873