Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2174 | NM |
NPI | 1003040973 |
---|---|
Provider Name | Brendan Tucker Casey |
First Address | Santa Fe, NM 87501 |
Second Address | Santa Fe, NM 87501-3617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2009 |
Last Update Date | 31/03/2021 |