Provider Demographics
NPI:1679601835
Name:PRECURE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:PRECURE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRECURE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-434-1455
Mailing Address - Street 1:2001 EAST 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4904
Mailing Address - Country:US
Mailing Address - Phone:575-434-1455
Mailing Address - Fax:575-443-1007
Practice Address - Street 1:2001 EAST 10TH STREET
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4904
Practice Address - Country:US
Practice Address - Phone:575-434-1455
Practice Address - Fax:575-443-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1632111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM300521107Medicaid
NM300521107Medicare PIN