Basic Information
| Provider Information | |||||||||
| NPI: | 1851594279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA TERESA CHIROPRACTIC CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8001 E. NORTH MESA | ||||||||
| Address2: | 325 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155909355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5300 MCNUTT RD | ||||||||
| Address2: | 3 | ||||||||
| City: | SANTA TERESA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880089606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155909355 | ||||||||
| FaxNumber: | 5055893227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARKER | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5055892554 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 1602 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.