Provider Demographics
NPI:1184640054
Name:HASTIE, ROSS EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:EDWARD
Last Name:HASTIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3503
Mailing Address - Country:US
Mailing Address - Phone:575-461-3228
Mailing Address - Fax:575-461-3228
Practice Address - Street 1:1723 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3503
Practice Address - Country:US
Practice Address - Phone:575-461-3228
Practice Address - Fax:575-461-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM338313201Medicare UPIN