Provider Demographics
NPI:1225043169
Name:PRECURE, MICHAEL R (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:PRECURE
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 1:2001 EAST TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8006
Mailing Address - Country:US
Mailing Address - Phone:575-434-1455
Mailing Address - Fax:575-443-1007
Practice Address - Street 1:2001 EAST TENTH STREET
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8006
Practice Address - Country:US
Practice Address - Phone:575-434-1455
Practice Address - Fax:575-443-1007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM202007699OtherPRESBYTERIAN
NM00KK91OtherBLUE CROSS BLUE SHIELD
NM343606002Medicaid
NM202007699OtherPRESBYTERIAN