Provider Demographics
NPI:1295864122
Name:SANDIA CHIROPRACTIC CARE PC
Entity Type:Organization
Organization Name:SANDIA CHIROPRACTIC CARE PC
Other - Org Name:GRETCHEN G PETERSON
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-299-4446
Mailing Address - Street 1:9601 SIERRA VISTA CT NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3422
Mailing Address - Country:US
Mailing Address - Phone:505-299-4446
Mailing Address - Fax:505-275-8505
Practice Address - Street 1:9601 SIERRA VISTA CT NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3422
Practice Address - Country:US
Practice Address - Phone:505-299-4446
Practice Address - Fax:505-275-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty