Healthcare Provider Details

I. General information

NPI: 1326916214
Provider Name (Legal Business Name): JOHN A KLAUCK JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TEN THOUSAND WAVES WAY
SANTA FE NM
87501-8704
US

IV. Provider business mailing address

PO BOX 10200
SANTA FE NM
87504-6200
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-5304
  • Fax:
Mailing address:
  • Phone: 505-992-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number10073245
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: