Healthcare Provider Details

I. General information

NPI: 1326271222
Provider Name (Legal Business Name): VINCENT JOHN PALLADINO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 CERRO GORDO RD # A2
SANTA FE NM
87501-6167
US

IV. Provider business mailing address

1330 CERRO GORDO RD # A2
SANTA FE NM
87501-6167
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-7677
  • Fax: 505-795-7112
Mailing address:
  • Phone: 505-983-7677
  • Fax: 505-795-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1673
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number1673
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: