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General NPI Number Information
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NPI Number | 1114320389
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Entity Type | Organization
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Legal Business Name | GDI VENTURE, INC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 1511 GOLF COURSE RD SE STE. C
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City | RIO RANCHO
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State | NM
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Zip | 87124-1956
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Country | US
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Telephone | 505-933-8600
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Fax | 505-933-8601
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Provider Business Mailing Address
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Address Line | 1511 GOLF COURSE RD SE STE. C
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City | RIO RANCHO
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State | NM
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Zip | 87124-1956
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Country | US
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Telephone | 505-933-8600
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Fax | 505-933-8601
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEAN CRAIG WASSON
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Credential | D.C., NM-APC
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Telephone | 505-933-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1664
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License Number State | NM
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