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General NPI Number Information
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NPI Number | 1457531360
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Entity Type | Organization
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Legal Business Name | NEW MEXICO FAMILY CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 3600 RODEO LN STE D2
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City | SANTA FE
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State | NM
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Zip | 87507-5803
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Country | US
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Telephone | 505-984-0821
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Fax | 505-984-0168
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Provider Business Mailing Address
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Address Line | 3600 RODEO LN STE D2
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City | SANTA FE
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State | NM
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Zip | 87507-5803
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Country | US
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Telephone | 505-984-0821
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Fax | 505-984-0168
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Authorized Official
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Title or Position | PRESIDENT/DOCTOR OF CHIROPRACTIC
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Name | DR. JEROME D BUENVIAJE
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Credential | D.C.
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Telephone | 505-984-0821
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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 | 1548
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1545
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License Number State | NM
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