Provider Demographics
NPI:1750483574
Name:POND, LONNIE L (DC)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:L
Last Name:POND
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:PO BOX 2332
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-2332
Mailing Address - Country:US
Mailing Address - Phone:505-325-5992
Mailing Address - Fax:505-327-5741
Practice Address - Street 1:2600 FARMINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4507
Practice Address - Country:US
Practice Address - Phone:505-325-5992
Practice Address - Fax:505-327-5741
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2671781Medicare PIN