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NPI Code Detail

MEDICARE: ROOT AND STEM CHIROPRACTIC LLC

MEDICARE: ROOT AND STEM CHIROPRACTIC LLC
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
1111N00000XChiropractor

General Provider Information

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

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Directions to “ROOT AND STEM CHIROPRACTIC LLC ” Practice Location

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