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General NPI Number Information
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NPI Number | 1811858962
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Entity Type | Organization
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Legal Business Name | ROOT AND STEM CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 2439 SAN PEDRO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4101
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Country | US
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Telephone | 505-403-6512
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Fax | 505-403-6512
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Provider Business Mailing Address
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Address Line | 2439 SAN PEDRO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4101
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Country | US
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Telephone | 505-403-6512
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Fax | 505-403-6512
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Authorized Official
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Title or Position | CEO
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Name | DR. MICKEY MONDRAGON
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Credential | DC
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Telephone | 505-403-6512
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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 |
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License Number State |
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