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General NPI Number Information
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NPI Number | 1831281054
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Entity Type | Individual
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Provider Name | DAMIEN SALVATORE PASSALACQUA D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 82 COUNTY ROAD 122 # A
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City | ESPANOLA
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State | NM
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Zip | 87532-3187
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Country | US
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Telephone | 505-753-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 199 A LOWER SAN PEDRO
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City | ESPANOLA
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State | NM
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Zip | 87532
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Country | US
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Telephone | 505-747-4952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1635
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License Number State | NM
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