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General NPI Number Information
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NPI Number | 1760605885
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Entity Type | Organization
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Legal Business Name | ESPANOLA FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 423 S RIVERSIDE DR STE A1
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City | ESPANOLA
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State | NM
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Zip | 87532-2980
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Country | US
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Telephone | 505-753-3001
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Fax | 505-753-3052
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Provider Business Mailing Address
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Address Line | 423 S RIVERSIDE DR STE A1
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City | ESPANOLA
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State | NM
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Zip | 87532-2980
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Country | US
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Telephone | 505-753-3001
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Fax | 505-753-3052
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN MICHAEL FOX
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Credential | DC
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Telephone | 505-753-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1497
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License Number State | NM
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