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General NPI Number Information
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NPI Number | 1811628019
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Entity Type | Organization
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Legal Business Name | TURQUOISE TRAIL THERAPEUTICS LLC
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 906 S SAINT FRANCIS DR STE E
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City | SANTA FE
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State | NM
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Zip | 87505-3097
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Country | US
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Telephone | 505-303-0262
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Fax | 505-393-8545
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Provider Business Mailing Address
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Address Line | 906 S SAINT FRANCIS DR STE E
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City | SANTA FE
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State | NM
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Zip | 87505-3097
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Country | US
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Telephone | 505-303-0262
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Fax | 505-393-8545
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | BRENDAN T CASEY
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Credential | DC
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Telephone | 505-690-1873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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