Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1339 | NM |
N | 111NN0400X | Neurology | 1339 | NM |
N | 111NS0005X | Chiropractic Sports Physician | 1339 | NM |
NPI | 1144385410 |
---|---|
Provider Name | Mr. Richard Peter Defelice |
First Address | Albuquerque, NM 87104-2061 |
Second Address | Albuquerque, NM 87104-2061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/02/2008 |