Healthcare Provider Details

I. General information

NPI: 1265627046
Provider Name (Legal Business Name): ELLENITA BRIDGET SALKO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLENITA BRIDGET CHAVEZ D.C.

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOSPITAL DR STE 300
SANTA FE NM
87505-4770
US

IV. Provider business mailing address

1650 HOSPITAL DR STE 300
SANTA FE NM
87505-4770
US

V. Phone/Fax

Practice location:
  • Phone: 505-629-3116
  • Fax:
Mailing address:
  • Phone: 505-629-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1599
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: