Provider Demographics
NPI:1144385410
Name:DEFELICE, RICHARD PETER (DC DOM)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PETER
Last Name:DEFELICE
Suffix:
Gender:M
Credentials:DC DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 RIO GRANDE BLVD NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-2061
Mailing Address - Country:US
Mailing Address - Phone:505-888-1004
Mailing Address - Fax:505-888-6812
Practice Address - Street 1:1301 RIO GRANDE BLVD NW
Practice Address - Street 2:SUITE 3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2061
Practice Address - Country:US
Practice Address - Phone:505-888-1004
Practice Address - Fax:505-888-6812
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1339111N00000X, 111NN0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NS0005XChiropractic ProvidersChiropractorSports Physician