Provider Demographics
NPI:1114662640
Name:SPORTS CHIROPRACTIC & MASSAGE LLC
Entity Type:Organization
Organization Name:SPORTS CHIROPRACTIC & MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-496-0992
Mailing Address - Street 1:4 CALLE MONTOYA
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-9302
Mailing Address - Country:US
Mailing Address - Phone:505-808-4739
Mailing Address - Fax:888-974-6127
Practice Address - Street 1:221 NM-165
Practice Address - Street 2:SUITE H
Practice Address - City:PLACITAS
Practice Address - State:NM
Practice Address - Zip Code:87043
Practice Address - Country:US
Practice Address - Phone:505-808-4739
Practice Address - Fax:888-974-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty