Provider Demographics
NPI:1518107416
Name:ALPHA AND OMEGA CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ALPHA AND OMEGA CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-258-5999
Mailing Address - Street 1:1123 MECHEM DR # 2
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7203
Mailing Address - Country:US
Mailing Address - Phone:575-258-5999
Mailing Address - Fax:
Practice Address - Street 1:1123 MECHEM DR # 2
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7203
Practice Address - Country:US
Practice Address - Phone:575-258-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM338726301Medicare Oscar/Certification