Provider Demographics
NPI:1982067906
Name:PASSALACQUA CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PASSALACQUA CHIROPRACTIC INC
Other - Org Name:DAMIEN PASSALACQUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:PASSALACQUA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-455-9909
Mailing Address - Street 1:40 TANGO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-7148
Mailing Address - Country:US
Mailing Address - Phone:505-455-9909
Mailing Address - Fax:505-455-9919
Practice Address - Street 1:17713 US 84/285
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-2668
Practice Address - Country:US
Practice Address - Phone:505-455-9909
Practice Address - Fax:505-455-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMV07201Medicare UPIN
NM941409000013001Medicare Oscar/Certification
NM347338Medicare PIN