=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881922748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASEY F ONIK DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2009
-----------------------------------------------------
Last Update Date | 05/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 ZAFARANO DR STE C PMB 249
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-500-5392
-----------------------------------------------------
Fax | 505-485-0641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 ZAFARANO DR STE C PMB 249
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-500-5392
-----------------------------------------------------
Fax | 505-485-0641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | A-1823-14
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A-1823-14
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------