Healthcare Provider Details

I. General information

NPI: 1255255956
Provider Name (Legal Business Name): SANTA FE SPORT AND SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
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: 505-303-3004
  • Fax:
Mailing address:
  • Phone: 505-303-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRENDAN TUCKER CASEY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 505-303-3004