Healthcare Provider Details

I. General information

NPI: 1346313848
Provider Name (Legal Business Name): MICHAEL NUNNALLY D.C., F.A.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 S SAINT FRANCIS DR STE A
SANTA FE NM
87505-4098
US

IV. Provider business mailing address

1482 S SAINT FRANCIS DR STE A
SANTA FE NM
87505-4098
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-7339
  • Fax:
Mailing address:
  • Phone: 505-982-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number732
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: