Provider Demographics
NPI:1831281054
Name:PASSALACQUA, DAMIEN SALVATORE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:SALVATORE
Last Name:PASSALACQUA
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 1:199 A LOWER SAN PEDRO
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532
Mailing Address - Country:US
Mailing Address - Phone:505-747-4952
Mailing Address - Fax:
Practice Address - Street 1:82 COUNTY ROAD 122 # A
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3187
Practice Address - Country:US
Practice Address - Phone:505-753-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3335318000Medicare ID - Type Unspecified