Provider Demographics
NPI:1114320389
Name:GDI VENTURE, INC
Entity Type:Organization
Organization Name:GDI VENTURE, INC
Other - Org Name:WELLSPRING CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, NM-APC
Authorized Official - Phone:505-933-8600
Mailing Address - Street 1:1511 GOLF COURSE RD SE
Mailing Address - Street 2:STE. C
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1956
Mailing Address - Country:US
Mailing Address - Phone:505-933-8600
Mailing Address - Fax:505-933-8601
Practice Address - Street 1:1511 GOLF COURSE RD SE
Practice Address - Street 2:STE. C
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1956
Practice Address - Country:US
Practice Address - Phone:505-933-8600
Practice Address - Fax:505-933-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU97238Medicare UPIN