Provider Demographics
NPI:1811628019
Name:TURQUOISE TRAIL THERAPEUTICS LLC
Entity Type:Organization
Organization Name:TURQUOISE TRAIL THERAPEUTICS LLC
Other - Org Name:TURQUOISE TRAIL THERAPEUTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-690-1873
Mailing Address - Street 1:906 S SAINT FRANCIS DR STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3097
Mailing Address - Country:US
Mailing Address - Phone:505-303-0262
Mailing Address - Fax:505-393-8545
Practice Address - Street 1:906 S SAINT FRANCIS DR STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3097
Practice Address - Country:US
Practice Address - Phone:505-303-0262
Practice Address - Fax:505-393-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty