MEDICARE: SANTA FE PAIN CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1136	NM

General Provider Information

NPI Number	:	1205917713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA FE PAIN CENTER, INC.

Provider Business Mailing Address
First Line	:	11 CALLE MEDICO
Second Line	:	SUITE 3
City	:	SANTA FE
State	:	NM
Zip	:	87505-4705
Country	:	US
Telephone Number	:	505-983-3037
Fax Number	:	505-982-3737

Provider Business Practice Location Address
First Line	:	11 CALLE MEDICO
Second Line	:	SUITE 3
City	:	SANTA FE
State	:	NM
Zip	:	87505-4705
Country	:	US
Telephone Number	:	505-983-3037
Fax Number	:	505-982-3737

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL CONNER CRAWFORD
Credential	:	D.C.
Telephone Number	:	505-983-3037

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/01/2008

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