MEDICARE: PASSALACQUA CHIROPRACTIC 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	1635	NM

General Provider Information

NPI Number	:	1982067906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSALACQUA CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	40 TANGO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-7148
Country	:	US
Telephone Number	:	505-455-9909
Fax Number	:	505-455-9919

Provider Business Practice Location Address
First Line	:	17713 US 84/285
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-2668
Country	:	US
Telephone Number	:	505-455-9909
Fax Number	:	505-455-9919

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAMIEN SALVATORE PASSALACQUA
Credential	:	D.C.
Telephone Number	:	505-455-9909

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	03/29/2016

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