Provider Demographics
NPI:1780846998
Name:GUERRERO, TINA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:BRUNKE-WEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DAC
Mailing Address - Street 1:325 S 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3117
Mailing Address - Country:US
Mailing Address - Phone:575-282-2222
Mailing Address - Fax:575-282-2224
Practice Address - Street 1:325 S 1ST STREET
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3117
Practice Address - Country:US
Practice Address - Phone:575-282-2222
Practice Address - Fax:575-282-2224
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X, 133N00000X
NMDC2274111N00000X
KS01-05206111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No111NN1001XChiropractic ProvidersChiropractorNutrition
No133N00000XDietary & Nutritional Service ProvidersNutritionist