Provider Demographics
NPI:1710424650
Name:ARAGON-ROSALES, JOLENE ALISANDRA (DC)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:ALISANDRA
Last Name:ARAGON-ROSALES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:ALISANDRA
Other - Last Name:ARAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1841B US HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-6784
Mailing Address - Country:US
Mailing Address - Phone:505-926-9300
Mailing Address - Fax:
Practice Address - Street 1:1841B US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-6784
Practice Address - Country:US
Practice Address - Phone:505-926-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor